CHAPTER He-M
500 DEVELOPMENTAL SERVICES
PART He-M 501 AUTISM REGISTRY
Statutory
Authority: RSA 171-A:31
He-M 501.01 Purpose. The purpose of these rules is to establish
and implement a state autism registry and thereby improve current knowledge and
understanding of autism spectrum disorder (ASD), allow the conducting of
thorough and complete epidemiologic surveys of the disorder, enable analysis of
the problem, and facilitate planning for services to children and adults with
ASD and their families.
Source. #9161, eff 5-17-08, EXPIRED: 5-17-16
New. #11103, INTERIM, eff 5-25-16, EXPIRED:
11-21-16
New. #12052, eff 11-18-16
He-M 501.02 Definitions. The words and phrases used in these rules
shall mean the following, except where a different meaning is clearly intended
from the context:
(a) “Autism registry” means the system
established under RSA 171-A:30, I for reporting and recording new instances of
autism spectrum disorder.
(b) “Autism spectrum disorder” (ASD) means a
developmental disorder of brain function that presents with:
(1) Persistent deficits in social communication
and social interaction across multiple contexts, as manifested by the
following, currently or by history:
a. Deficits in social-emotional reciprocity;
b.
Deficits in nonverbal communicative behaviors used for social
interaction; and
c.
Deficits in developing, maintaining, and understanding relationships;
(2) Restricted, repetitive patterns of behavior,
interests, or activities, as manifested by at least 2 of the following,
currently or by history:
a.
Stereotyped or repetitive motor movements, use of objects, or speech;
b.
Insistence on sameness, inflexible adherence to routines, or ritualized patterns
of verbal or nonverbal behavior;
c.
Highly restricted, fixated interests that are abnormal in intensity or
focus; or
d.
Hyper- or hyporeactivity to sensory input or unusual interests in
sensory aspects of the environment;
(3) Symptoms that are present in the early
developmental period, but might not become fully manifest until social demands
exceed limited capacities, or might be masked by learned strategies in later
life;
(4) Symptoms that cause clinically significant
impairment in social, occupational, or other important areas of current
functioning; and
(5) Disturbances
that are not better explained by intellectual disability or global
developmental delay.
(c) “Bureau” means the bureau of developmental
services of the department of health and human services.
(d) “Commissioner” means the commissioner of the
department of health and human services or his or her designee.
(e) “Patient” means a person diagnosed as having
ASD.
(f) “Reporter” means any physician, psychologist,
or other licensed or certified health care provider who is qualified by
training to make the diagnosis of ASD.
Source. #9161, eff 5-17-08, EXPIRED: 5-17-16
New. #11103, INTERIM, eff 5-25-16, EXPIRED: 11-21-16
New. #12052, eff 11-18-16
He-M 501.03 Establishment of the Autism Registry. The commissioner shall implement and maintain
a computerized autism registry as established in RSA 171-A:30, I.
Source. #9161, eff 5-17-08, EXPIRED: 5-17-16
New. #11103, INTERIM, eff 5-25-16, EXPIRED:
11-21-16
New. #12052, eff 11-18-16
He-M 501.04 Methods of Submission and Content of
Records.
(a) Reporters shall submit to the bureau
demographic and diagnostic information pertaining to each patient newly
diagnosed as having ASD. Such records
shall be submitted via:
(1) An electronic interface available at http://business.nh.gov/dhhs_
autism/Autism.aspx,; or
(2) Written records.
(b) Demographic and diagnostic information
submitted regarding each patient shall include the patient’s:
(1) First initial of last name;
(2) Last 4 digits of social security number, if
applicable;
(3) Date of birth;
(4) Gender;
(5) City, county, state, and zip code of birth
residence;
(6) Residence, including city or town and zip
code, at time of diagnosis;
(7) Ethnicity, identified as either:
a. American Indian or Alaskan Native;
b. Asian;
c. Hispanic;
d. Non-Hispanic Black;
e. Non-Hispanic White;
f. Native Hawaiian or other Pacific Islander;
g. Not reported; or
h. Other, specified;
(8) Specific diagnosis, identified as either:
a. Autism spectrum disorder;
b. Asperger’s syndrome;
c. Pervasive developmental disorder, not
otherwise specified (PDD-NOS);
d. Other PDD;
e. Atypical Autism; or
e. Childhood autism; and
(9) Date of diagnosis.
(c) Reporters submitting records to the autism
registry shall include the reporter’s:
(1) Full name;
(2) Address, including:
a. Street or P.O. box;
b. City or town;
c. State; and
d. Zip code;
(3) Phone number;
(4) E-mail address;
(5) Licensure type;
(6) Highest educational degree attained;
(7) Specialty and subspecialty, if applicable;
and
(8) Signature and date signed.
(d) The bureau shall assign a unique identifying
code to each patient. The code shall not
include the patient’s name or address.
(e) The bureau shall supply to reporters an
informational notice describing the purposes of the autism registry and the
name, phone number, and e-mail address of a contact person for questions.
(f) Each reporter
shall:
(1) Post the informational notice described in
(e) above conspicuously in his or her place of practice; and
(2) Inform each patient, parent of a patient who
is a minor child, or guardian, as applicable, of the
reporting requirements under the registry law, RSA 171-A:30.
Source. #9161, eff 5-17-08, EXPIRED: 5-17-16
New. #11103, INTERIM, eff 5-25-16, EXPIRED: 11-21-16
New. #12052, eff 11-18-16
He-M 501.05
Security Regarding the Autism Registry. To ensure confidentiality, all information
submitted to the registry shall be stored in a secure file and database.
Source. #9161, eff 5-17-08, EXPIRED: 5-17-16
New. #11103, INTERIM, eff 5-25-16, EXPIRED:
11-21-16
New. #12052, eff 11-18-16
He-M 501.06
Access to the Autism Registry By Third Parties. Upon request, the commissioner shall release
analyses and compilations of demographic and diagnostic records that do not
disclose the identity of the registrants to:
(a)
Providers;
(b)
Insurers;
(c)
Managed care organizations;
(d)
Researchers; and
(e)
Governmental agencies.
Source. #9161, eff 5-17-08, EXPIRED: 5-17-16
New. #11103, INTERIM, eff 5-25-16, EXPIRED:
11-21-16
New. #12052, eff 11-18-16
PART He-M 502 RECORDS STANDARDS FOR INDIVIDUALS SERVED -
DEVELOPMENTAL SERVICES
Statutory Authority: RSA 171-A:3: 18, IV
REVISION NOTE:
Document #5046,
effective 1-18-91, made extensive changes to the wording, format, structure,
and numbering of rules in Part He-M 502.
Document #5046 supersedes all prior filings for the sections in this
chapter. He-M 502.04, 502.05, 502.06,
and 502.07 were new with Document #5046.
The prior filings affecting rules in former Part He-M 502 include the
following documents:
#2746, eff 6-14-84
He-M 502.01 – 502.09 - EXPIRED
Source. (See Revision Note at part heading for He-M
502) #5046, eff 1-18-91, EXPIRED: 1-18-97
New. #6646, eff 12-2-97, EXPIRED: 12-2-05
PART He-M 503 ELIGIBILITY AND THE PROCESS OF PROVIDING
SERVICES
Statutory Authority: RSA 171-A:3; 18, IV
He-M
503.01 Purpose. The purpose of these rules is to
establish standards and procedures for the determination of eligibility, the
development of service agreements, and the provision and monitoring of services
which maximize the ability and informed decision-making authority of individuals
with developmental disabilities and which promote the individual’s personal
development, independence, and quality of life in a manner that is determined
by the individual.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15;
ss by #13841, eff 12-29-23
He-M 503.02 Definitions.
(a) “Amendment” means any change to the personal
profile, provider agency, or provision of services, including the amount, scope, type, frequency, or duration, within a service
agreement.
(b) “Applicant”
means any person who requests services under RSA l71-A.
(c) “Area”
means “area” as defined in RSA 171-A:2, I-a, namely,
“a geographic region established by rules adopted by the commissioner for the
purpose of providing services to developmentally disabled persons.” This term
includes “region”.
(d) “Area
agency” means “area agency” as defined in RSA 171-A:2, I-b.
(e) “Area
agency director” means that person who is appointed as executive director or
acting executive director of an area agency by the
area agency’s board of directors.
(f) “Assistive
technology” means technology designed to be utilized in an “assistive
technology device” as defined in 29 U.S.C. section 3002(4) or “assistive
technology service” as defined in 29 U.S.C. section 3002(5).
(g) “Autism,” also called “autism spectrum disorder” means a
developmental disorder of brain function that presents with:
(1) Persistent
deficits in social communication and social interaction across multiple
contexts, as manifested by the following, currently or by history:
a. Deficits
in social-emotional reciprocity;
b. Deficits in nonverbal communicative behaviors used for social
interaction; and
c. Deficits in developing, maintaining, and understanding relationships;
(2) Restricted, repetitive patterns of behavior, interests, or
activities, as manifested by at least 2 of the following, currently or by
history:
a. Stereotyped or repetitive motor movements, use of objects, or speech;
b. Insistence on sameness, inflexible adherence to routines, or
ritualized patterns of verbal or nonverbal behavior;
c. Highly restricted, fixated interests that are
abnormal in intensity or focus; or
d. Hyper- or
hyporeactivity to sensory input or unusual interests in sensory aspects of the
environment;
(3) Symptoms
that are present in the early developmental period, but might not become fully manifested until social demands exceed limited capacities, or might
be masked by learned strategies in later life;
(4) Symptoms that cause clinically significant impairment in social,
occupational, or other important areas of current functioning; and
(5) Disturbances that are not better explained by intellectual disability
or global developmental delay.
(h) “Bureau”
means the bureau of developmental services of the department of health and
human services.
(i) “Bureau administrator” means the chief administrator of the bureau
of developmental services.
(j) “Cerebral
palsy” means a condition resulting from brain damage occurring in utero or
during infancy or childhood and characterized by permanent motor impairment
that constitutes a severe disability to such individual’s ability to function
normally in society.
(k) “Commissioner” means the commissioner of the department of health and
human services or their designee.
(l) “Comprehensive risk assessment” means an
evaluation administered pursuant to He-M 503.09(m)(11) using evidence-based tools to evaluate an individual’s behaviors and
determine the potential risks to the individual or others posed by said
behaviors.
(m) “Conditional
eligibility” means a category of eligibility where a person under the age of 22
is determined to have a developmental disability only provisionally because
either the diagnostic information is inconclusive or it cannot yet be determined whether the disability will continue
indefinitely.
(n) “Days” means
calendar days unless otherwise specified.
(o) “Department” means the New Hampshire department of health
and human services.
(p) “Developmental disability” means “developmental disability” as defined in
RSA 171-A:2, V, namely, “a disability:
(1) Which
is attributable to an intellectual disability, cerebral palsy, epilepsy, autism,
or a specific learning disability, or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual
functioning or impairment in adaptive behavior or requires treatment similar to
that required for persons with an intellectual disability; and
(2) Which
originates before such individual attains age 22, has continued or can be
expected to continue indefinitely, and
constitutes a severe disability to such individual’s ability to function
normally in society.”
(q) “Epilepsy”
means a neurological condition characterized by recurrent seizures which might
be accompanied by loss of consciousness, convulsive movements, or disturbances
of feeling, thought, or behavior and constitutes a severe disability to such
individual’s ability to function normally in society.
(r) “Guardian”
means a person appointed pursuant to RSA 463 or RSA 464-A or the parent of an
individual under the age of 18 whose parental rights have not been terminated
or limited by law.
(s) “Health Risk Screening
Tool (HRST)” means the 2015 edition of the Health Risk Screening Tool,
available as noted in Appendix A, which is a web-based rating instrument used
for performing health risk screenings on individuals in order to:
(1) Determine an individual’s vulnerability regarding potential health
risks; and
(2) Enable
the early identification of health issues and monitoring of
health needs.
(t) “Home
and community-based waiver services (“waiver services”) ” means the services
defined and funded pursuant to New Hampshire’s agreement with the federal
government, known as the Developmental Disabilities Waiver, pursuant to the
authority of section 1915(c) of the Social Security Act which allows the
federal funding of long-term care services in non-institutional settings for
persons who are developmentally disabled.
(u) “Individual”
means a person who has a developmental disability.
(v) “Informed
consent” means a decision made voluntarily by an individual or applicant for
services or, where appropriate, such person's legal guardian or representative,
after all relevant information necessary to making the choice has been
provided, when the person understands that they are free to choose or refuse
any available alternative, when the person clearly indicates or expresses their
choice, and when the choice is free from all coercion.
(w) “Intellectual
disability” means “intellectual disability” as defined in RSA 171-A:2, XI-a,
namely, “significantly subaverage general intellectual functioning existing
concurrently with deficits in adaptive behavior, and manifested during the
developmental period. A person with an intellectual disability may
be considered mentally ill provided that no person with an intellectual
disability shall be considered mentally ill solely by virtue of his or her
intellectual disability.”
(x) “Local
education agency (LEA)” means “local education agency” as defined in 34
CFR 300.28. This term includes “school district” as defined in Ed 1102.03(n).
(y) “Participant
directed and managed services” means a method of service delivery provided
pursuant to He-M 525.
(z) “Person-centered service planning” is an
individual-directed, positive approach to the planning and coordination of a
person’s services and other supports based on the individual’s aspirations,
needs, preferences, and goals.
(aa) “Personal
profile” means a narrative description that includes a personal statement from
the individual and those who know them best that summarizes the individual’s
strengths and capacities, communication and learning style, challenges, needs,
interests, and any health concerns, as well as the individual’s hopes and
dreams.
(ab) “Provider”
means a person receiving any form of remuneration for the provision of services
to an individual.
(ac) “Provider
agency” means an agency or an independent provider that is established to
provide services to individuals and meets the criteria in He-M 504.
(ad) “Representative”
means:
(1) The parent or guardian of an individual under the age of 18;
(2) The
guardian of an individual 18 or over; or
(3) A
person who has power of attorney for the individual.
(ae) “Service”
means any paid assistance to an individual in meeting their own needs provided
through the developmental services system.
(af) “Service
agreement” means a written agreement between the individual, guardian, or
representative and provider agencies that is prepared as a result of the
person-centered service planning process and that describes the services that
an individual will receive and constitutes an individual service agreement as
defined in RSA 171-A:2, X and developed pursuant to He-M 503.10.
(ag) “Service coordination agency” means a provider
agency providing service coordination services to individuals, that meets the
criteria in He-M 504.
(ah) “Service
coordinator” means a provider who meets the criteria in He-M 503.08 (b)
and(c) and is chosen by an individual and their guardian or representative
to organize, facilitate and document service planning and to negotiate and
monitor the provision of the individual’s services.
(ai) “Service planning meeting” means a gathering of
2 or more people, one of whom is the individual who receives services unless they
choose not to attend, called to develop,
review, add to, delete from, or otherwise change a service agreement.
(aj) “Specific learning disability” means a
chronic condition of presumed neurological origin that selectively interferes
with the development, integration, or demonstration of verbal or non-verbal
abilities, and constitutes a severe disability to such individual’s ability to
function normally in society. The term includes such conditions as
perceptual handicaps, brain injury, dyslexia, and developmental
aphasia. The term does not include individuals who have learning problems
which are primarily the result of visual, hearing, or motor handicaps,
intellectual disability, emotional disturbance, or environmental, cultural, or
economic disadvantage.
(ak) “State of residence”
means state of residence as defined in 42 CFR 435.403.
(al) “Supported decision-making” means “supported-decision
making” as defined in RSA 464-D: 4, VI.
(am) “Supports Intensity Scale-Adult Version ®
(SIS-A ®)” means the 2023 edition of the Supports Intensity Scale, available as
noted in Appendix A, which is an assessment tool intended to assist in service
planning by measuring the individual’s support needs in the areas of home
living, community living, lifelong learning, employment, health and safety,
social activities, and protection and advocacy. The tool uses a formal rating
scale to identify the type of supports needed, frequency of supports needed, and
daily support time.
(an) “Termination”
means the cessation of a service by an area agency director with or without the
informed consent of the individual or their guardian or representative.
(ao) “Withdrawal”
means the choice of an individual or their guardian to discontinue that
individual’s participation in a service.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15;
ss by #13841, eff 12-29-23
He-M
503.03 Eligibility for Services.
(a) Pursuant
to RSA 171-A, and as referenced in He-M 503.02 (ak) and (o), any person whose
state of residence is New Hampshire and who has a developmental disability
shall be eligible for services as described in (b) through (h) below.
(b) Individuals
who meet the requirements of (a) above, shall be eligible under He-M 503 to
receive the following services:
(1) Service coordination;
(2) Family support services pursuant to He-M 519;
(3) Respite services pursuant to He-M 513; and
(4) Other
applicable services available pursuant to He-M 500 that are needed as determined
in accordance with He-M 503.05, except those that are the legal responsibility
of the local education agency (LEA) pursuant to the Interagency Agreement in
accordance with RSA 186-C:7-a, the department’s division for children, youth
and families (DCYF), or another state agency to provide.
(c) Individuals
described in (a) above shall also be eligible for home and community-based waiver
services if they meet the requirements of He-M 517.03.
(d) Individuals
described in (a), from birth through 21 who have not graduated or exited the
school system and who live at home shall be eligible for in-home support
services if the requirements of He-M 524.03 are met.
(e) Individuals
described in (a) above who are under age 3 shall also be eligible for
family-centered early supports and services if the requirements of He-M 510.06
are met.
(f) An
applicant under the age of 18 who has a developmental disability cited in He-M
503.02 (o) at the time of application shall be found conditionally eligible for
services if either the diagnostic information is inconclusive or it cannot be
determined whether the disability will continue indefinitely.
(g) When
the eligibility of an individual has been determined to be conditional, the
eligibility for services shall be periodically reviewed pursuant to He-M 503.06
so that the area agency can reach a conclusive decision before the individual
turns age 18.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15;
ss by #13841, eff 12-29-23
He-M
503.04 Application for Services.
(a) Application for
services shall be made by:
(1) The
applicant;
(2) A
guardian of an applicant under the age of 18;
(3) A
guardian of an applicant age 18 or over if a guardian of the person
has been appointed by the probate court per RSA 464-A; or
(4) A
representative of the applicant authorized to make such application.
(b) An
application for services shall be made in writing to the area agency in
the applicant’s region of residence.
(c) An
area agency shall explain the eligibility process and offer assistance to the
applicant, guardian, or representative in making application for services.
(d) The
area agency shall inform the applicant, guardian, or representative of its
roles and responsibilities and provide information about:
(1) The
types of evaluations, assessments, and screenings needed to assist in
development of the service agreement;
(2) Eligibility determination;
(3) Service coordination;
(4) Service agreement development and review;
(5) Services provided by the area agency and the assistance available
to identify the services that are needed;
(6) Service provision;
(7) Service monitoring; and
(8) Advocacy
supports.
(e ) To
aid in the provision of comprehensive, efficient, and coordinated services, the
area agency shall undertake a review of the public and private benefits and
resources that are available to the applicant and inform the applicant of all
such benefits and resources.
(f) To
receive services beyond age 3, the eligibility of a child served in
family-centered early supports and services shall be determined by the area
agency pursuant to He-M 503.03 and He-M 503.05 prior to the date the child
turns age 3, without the need of the family reapplying for
services. The eligibility determination process shall be initiated
by the area agency at least 90 days prior to the child’s third birthday.
(g) An
area agency shall request each applicant to authorize the release of
information to permit the area agency to access relevant current and historical
records and information for determination of eligibility pursuant to He-M 503.03
regarding the applicant’s:
(1) Developmental disabilities;
(2) Personal, family, social, educational, psychological, and medical
status; and
(3) Functional abilities, interests, and aptitudes.
(h) Authorization to
release information shall specify:
(1) The
name of the applicant and the information to be released;
(2) The
name of the person or organization being authorized to release
the information;
(3) The
name of the person or organization to whom the information is
to be released; and
(4) The
time period for which the authorization is given, which shall not exceed one
year.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15;
ss by #13841, eff 12-29-23
He-M
503.05 Determination of Eligibility.
(a) To
determine the existence of an applicant’s developmental disability, the area
agency shall perform a comprehensive screening evaluation consisting of:
(1) Reviewing
available information, including, but not limited to:
a. Birth, developmental, and educational histories;
b. Current
physical, intellectual, cognitive, and behavioral evaluations;
c. An age-appropriate standardized functional assessment; and
d.
As applicable, additional specialty medical, health, or clinical evaluations,
such as communication, functional behavior, psychological,
or psychopharmacological assessments, assistive technology, and personal safety
or comprehensive risk assessments; and
(2) Gathering
additional information and performing the additional evaluations among those
listed in (1) above that are necessary to complete the determination, if the
information available is not adequate to make a determination of eligibility.
(b) The
results of the comprehensive screening evaluation pursuant to (a) above and any
other information concerning the applicant’s disability shall be the basis for
determination of eligibility pursuant to He-M 503.03 and assist in the
identification of needs and provision of services.
(c) To
the extent possible, the area agency shall utilize generic resources to pay for
an applicant’s comprehensive screening evaluation. Such resources
shall, with the applicant’s consent, include private and public insurance.
(d) An
area agency shall review the information it has received regarding an applicant
and, within 15 business days after the receipt of the completed application,
make and communicate one of the following decisions on the eligibility of the
applicant in accordance with He-M 503.03 to the applicant, guardian, or
representative:
(1) Eligible;
(2) Conditionally eligible pursuant to He-M 503.02(l);
or
(3) Ineligible.
(e) If an area agency determines additional
information is necessary in order to make a determination in accordance with
(d) above, a communication detailing the additional information necessary shall
be provided to the applicant, guardian, or representative, and the application
shall not be determined complete until all necessary information has been
received by the area agency.
(f) In
cases where the information on eligibility is inconclusive, the area agency may
consult with the bureau regarding determination of eligibility prior to making
a decision in accordance with (d) above.
(g) Decisions by the bureau in (f) above shall be
made within 5 business days.
(h) In instances where consultations in (f) above
would cause the area agency’s decision pursuant to (d) above to exceed 15
business days, an additional 7 business days shall be allowed to make such
decision.
(i) A written denial of eligibility pursuant to
(d)(3) above, shall describe the specific legal and factual basis for the
denial, including specific citation of the applicable law or department rule,
and advise the applicant of the appeal rights under He-M 503.16.
(j) Following denial of eligibility, the
applicant, guardian, or representative, as applicable, may reapply for services
if new information regarding the diagnosis, age of onset, or severity of the
disability becomes available.
(k) Communication of approval or conditional
eligibility in accordance with (d)(1) or (2) above shall include a contact
person at the area agency.
(l) Preliminary planning to determine the services
needed shall occur with the individual and guardian, or representative at the
time of intake or during subsequent discussions. Preliminary evaluations shall be completed
and preliminary recommendations for services shall be made within 21 days of a
completed application for service.
(m) Within
3 days of the determination of an applicant’s eligibility under He-M 503.05 (d)(1)
or (2), an area agency shall review 1915(c) of the Social Security Act, home
and community-based waiver services with the individual, guardian, or
representative in order to make a decision.
(n) If the individual, guardian, or representative
is interested in pursuing home and community-based waiver services within the
next 12 months, within 5 business days of the individual’s decision pursuant to
(m) above, the area agency shall submit an application for waiver level of care
eligibility pursuant to He-M 517.03 to the bureau.
(o) The
bureau shall review an application submitted pursuant to (n) above and make a
decision within 15 business days of receipt of the application.
(p) Within 3 days of the decision, the bureau
shall communicate the decision to the area agency and the individual, guardian,
or representative in writing.
(q) If the bureau determines the individual is not
eligible for services in He-M 517, the notice shall include the specific legal
and factual basis for the determination, including a specific citation to the
applicable law or department rule, and the bureau shall advise the individual,
guardian, or representative in writing of the appeal rights under He-M 517.09.
(r) If there is not sufficient information to
determine the individual’s level of care, a request for additional information
shall be sent by the bureau to the submitting entity to allow an additional 10
days to provide information sufficient to determine level of care.
(s) If information to determine is not provided, the
bureau shall deny the level of care application, however, if new information
becomes available after such denial, a new application may be submitted.
(t) Pursuant to RSA 171-A:6, IV, in an emergency
situation, temporary service arrangements may be made prior to the completion
of the evaluation in (a) above if the bureau administrator, or designee, first
determines that the individual meets one of the following:
(1) Is a victim of abuse or neglect pursuant to
He-E 700;
(2) Is abandoned and homeless;
(3) Is without a caregiver due to death or
incapacitation;
(4) Is at significant risk of physical or
psychological harm due to decline in their medical or behavioral status; or
(5) Is presenting a significant risk to community
safety.
(u) The determination of
eligibility by one area agency, pursuant to He-M 503.05(d), shall be accepted
by every other area agency in the state.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97; ss by #10774, INTERIM, eff 1-29-15, EXPIRES:
7-27-15
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15;
ss by #13841, eff 12-29-23
He-M
503.06 Periodic Review of Conditional Eligibility.
(a) Subsequent
to finding an individual to be conditionally eligible for services pursuant to
He-M 503.03 (f), the area agency shall render a definitive decision on
eligibility before the individual reaches the age of 18.
(b) To
determine whether the applicant is eligible, the area agency shall, at minimum,
arrange for reevaluations:
(1) Anytime
during the ages of 7 through 9;
(2) Anytime
during the ages of 12 through 14; and
(3) Not
later than the individual’s 18th birthday.
(c) If
any of the reevaluations pursuant to (b) above, or any other information
obtained subsequent to finding an applicant conditionally eligible,
demonstrates to the area agency that a person is eligible for services pursuant
to He-M 503.03 (a), any subsequent required reevaluations to determine
eligibility shall not be performed.
(d) If
the results of any of the reevaluations, or any other information obtained
subsequent to finding an applicant conditionally eligible, demonstrate to the
area agency that the applicant’s disability will continue indefinitely or the
diagnosis is conclusive as defined in He-M 503.02 (o), the area agency shall
determine them eligible for services and so inform the applicant, guardian, or
representative in writing.
(e) If
the results of any of the reevaluations demonstrate that the applicant does not
meet the criteria as defined in He-M 503.02 (o), the area agency shall inform
the applicant, guardian, or representative in writing no more than 3 business
days from the determination of ineligibility and phase out services over the 12
months following the date of notice. The
phase plan shall be outlined through a service agreement.
(f) In
each instance where the reevaluation leads to a denial of eligibility, the area
agency shall, in writing:
(1) Inform
the applicant, guardian, or representative of the determination;
(2) Describe
the specific legal and factual basis for the denial, including specific
citation of the applicable law or department rule; and
(3) Advise
the applicant of the appeal rights under He-M 503.16.
(g) An
applicant, guardian, or representative may appeal a denial of eligibility based
on the reevaluation pursuant to He-M 503.16 and He-C 200.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15;
ss by #13841, eff 12-29-23
He-M
503.07 Service Guarantees.
(a) Except
as provided by RSA 171-B, all services shall:
(1) Be
voluntary;
(2) Be
provided only after the informed consent of the individual, guardian, or
representative;
(3) Comply
with the rights of the individual established under RSA 171-A:13-14, He-M 310,
and federal laws and rules; and
(4) Maximize
as much as possible the individual’s ability to determine and direct the
services they will receive, in accordance with federal and state laws and rules.
(b) All
services shall be designed to:
(1) Promote
the individual’s personal development and quality of life in a manner that is
determined by the individual;
(2) Meet
the individual’s needs in life skills to promote independent living:
a. Including
educational activities with the purpose of assisting the individual in
attaining or enhancing community living skills, or adaptive skill development to assist the
individual in residing in the most appropriate setting for their needs; and
b. Not
including post-secondary education, regardless of whether it leads to a degree,
or private tutoring;
(3) Promote
the individual’s health and safety within the bounds of reasonable risk;
(4) Protect
the individual’s right to freedom from abuse, neglect, and exploitation;
(5) Increase
the individual’s participation in a variety of integrated activities and
settings;
(6) Provide
opportunities for the individual to exercise personal choice, independence, and
autonomy within the bounds of reasonable risks;
(7) Enhance
the individual’s ability to perform personally meaningful or functional
activities;
(8) Assist
the individual to acquire and maintain life skills, such as, managing a
personal budget, participating in meal preparation, or traveling safely in the
community, including accessing community transportation;
(9) Be
provided in such a way that the individual is seen as a valued, contributing
member of their community; and
(10) Meet the individual’s needs in accordance with
He-M 503.09(m).
(c) The
environment or setting in which an individual receives services shall be the
least restrictive, most integrated setting that promotes that individual’s:
(1) Freedom
of movement;
(2) Ability
to make informed decisions;
(3) Self-determination;
(4) Participation
in the community in accordance with 42 CFR 441.301; and
(5) Rights
in accordance with He-M 310.
(d) An
individual, guardian, or representative may select any available provider that
is qualified pursuant to He-M 504, to deliver one or more of the services
identified in the individual’s service agreement. All provider
agencies and providers shall comply with the administrative rules and terms of
the waiver when applicable, pertaining to the service(s) offered and meet the
provisions specified within the individual’s service agreement.
(e) The area agency shall notify each individual,
annually, that they have a right to choose their service coordinator who meets
the requirements in He-M 503.08(a).
(f) No
one shall be denied an opportunity for services on the basis of the severity of
their developmental disability.
(g) An
area agency shall monitor timeliness of the completion of annual service
agreements by the service coordinator for all individuals, with the exception
of those individuals or families who request only information and referral.
(h) Area agencies and provider agencies shall inform
individuals and applicants of their rights under these rules in clearly
understandable language and form.
(i) For individuals who require a positive
behavior plan, emergency physical restraint shall only be approved for safely
responding to situations in which the individual presents with imminent
credible risk of significant harm to self or others by providers who are
trained and certified in recognized intervention modalities.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss
by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(from He-M 503.08); ss by #13841, eff 12-29-23
He-M
503.08 Service Coordination.
(a) The
service coordinator shall be a person chosen by the individual, guardian, or
representative who meets the criteria in He-M 504, He-M 506, and He-M
503.08 (b)-(c) below.
(b) The
service coordinator shall:
(1) Advocate
on behalf of individuals for services to be provided in accordance with the
service guarantees in He-M 503.07 (b);
(2) Coordinate
the service planning process in accordance with He-M 503.07, He-M 503.09, and
He-M 503.10;
(3) Describe
to the individual, guardian, or representative service delivery options including
participant directed and managed services;
(4) Monitor
and document services provided to the individual in accordance with He-M 503.10
below and He-M 517 for home and community-based waiver services;
(5) Ensure
continuity and quality of services provided in the amount, scope, frequency, and
duration as outlined in the service agreement;
(6) Monitor
and document quality of services provided in accordance with He-M 503.10 below
and He-M 517 for home and community-based waiver services;
(7) Provide
crisis and critical incident coordination and planning;
(8) Ensure
that service documentation is maintained pursuant to He-M 503.10 (c) and (l)(2)-(3)
and He-M 517 for home and community-based waiver services;
(9) Determine
and implement necessary action and document resolution when goals are not being
addressed, support services are not being provided in accordance with the
service agreement, or when health or safety issues have arisen;
(10) Convene
person-centered service planning meetings at least annually and whenever:
a. The individual, guardian, or representative is not satisfied with the
services received;
b. There is no progress on the goals after follow-up interventions;
c. The individual’s needs change;
d. There is a need for a new provider agency; or
e. The individual, guardian, or representative requests a meeting;
(11) Document
service coordination visits and contacts pursuant to He-M 503.09 (u) and He-M
503.10 (l) (2)-(4);
(12) No
less than 45 days in advance of the annual person-centered service planning
meeting:
a. Ensure
that all needed evaluations, screenings, or assessments, such as the SIS-A ®,
HRST, assistive technology evaluation, comprehensive risk assessments, positive
behavior plans, and other clinical or health evaluations are updated and, if
necessary, performed and that information from said evaluations, screenings,
and assessments is discussed and shared with the individual, guardian, or
representative;
b. Identify risk factors and plans to minimize them;
c. Assess the individual’s interest in, or satisfaction with,
employment; and
d. Discuss and assess the individual’s progress on goals and preparing
for the development of new goals to be included in the new service agreement;
(13) Assist
the individual, guardian, or representative to maintain the individual’s public
benefits; and
(14) Participate in risk management activities by:
a. Making referrals to the applicable area
agency’s local risk management committee for individual’s exhibiting behaviors including but not limited to violent aggression,
problematic sexual behaviors, or fire-setting behaviors for evaluations or
planning activities initially and ongoing;
b. Participating in and presenting to committees
and other groups related to risk management including, but not limited to,
local human rights committees, statewide and local risk management committees,
and community of practice to determine application of assessment
recommendations received;
c. Attending risk
management training activities; and
d. Attending clinically specialized trainings,
based on assessed needs of the individuals supported, that
enable successful completion of and participation in risk management
activities.
(c) A
service coordinator shall not:
(1) Be
a guardian or representative of the individual whose services they are coordinating;
or
(2) Have
a conflict of interest concerning the individual, such as providing, or being
employed by the provider agency that also provides other direct services to the
individual, except in accordance with He-M 503.08(d) and (e) below.
(d) A provider agency that provides direct
services to the individual and seeks to also provide service coordination, shall
be determined the only willing and qualified service coordination agency and permitted
to provide service coordination and direct services if the following criteria
are met:
(1) There is a lack of another qualified service
coordination agency willing to provide services to the individual as outlined
in their service agreement;
(2) The individual, guardian, or representative agrees
that the same agency shall provide both service coordination and direct services;
(3) The agency ensures that service coordination
and direct services are located in different departments and different physical
locations within the organization, and report to separate and equal
organizational leadership; and
(4) The direct services department shall not
develop or have any influence on developing the individual’s service agreement.
(e) A provider agency requesting determination to
serve as the only willing and qualified service coordination agency in
accordance with (d) above shall complete and submit the form entitled “NH
Bureau of Developmental Services Exemption Request” (December 2023) along with the
following documentation:
(1) Documentation that the criteria outlined in He-M 503.08(d)(1)
through (4) above has been met;
(2) Such agency’s plan to develop or recruit service
coordination agencies;
(3) Documentation of service coordinator
orientation and training that outlines the role of the service coordinator as a
neutral facilitator and how to offer choice to individuals;
(4) Documentation of how such agency ensures all
individuals, guardians, and representatives have accurate and accessible
information relative to service providers; and
(5) Documentation to demonstrate how such agency
monitors that choice is given to individuals, guardians, and representatives.
(f) Upon review of the form submitted pursuant to
(e) above, the bureau shall approve such a request if all the requirements are met.
(g) The approval of being the only willing and
qualified service coordination agency shall be for one year.
(h) After approval of an initial exemption
request, the agency in (e) above shall resubmit to the department a “NH Bureau
of Developmental Services Exemption Request” form (December 2023) annually.
(i) The documentation required in (e)(1)-(4) shall
only be required with the initial request.
(j) Subsequent requests shall not require the described
documentation provided that the only willing and qualified service coordination
agency certifies that there have been no changes to the original documentation
submitted.
(k) Once an only willing and qualified service
coordination agency request has been approved in accordance with (f) or (j)
above, the bureau shall conduct ongoing quarterly monitoring regarding the
criteria in (d)(1) above.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(from He-M 503.09); ss by #13841, eff 12-29-23
He-M
503.09 Service Planning.
(a) Preliminary
planning for services shall be done in accordance with He-M 503.05(l).
(b) Within 15 days of an
individual’s eligibility or conditional eligibility pursuant to He-M 503.05(d)
or level of care approval pursuant to He-M 503.05(o), for those for whom an
application for home and community-based waiver services has been submitted
pursuant to He-M 503.05(n), the area agency shall assist the individual,
guardian, or representative with resources to select a service coordinator.
(c) In instances when an individual has been
determined eligible pursuant to He-M 503.05(d), and declines services available
pursuant to He-M 503.05(l) and (m), the area agency shall assign a service
coordinator within 30 days.
(d) In instances when a service coordinator
has been assigned pursuant to (c) above, the service coordinator shall, at
minimum, contact the individual annually to discuss ongoing needs and determine
if service planning is desired.
(e) The
service coordinator shall hold an initial person-centered service planning
meeting to determine the individual’s goals and service needs in meeting those
goals with the individual, the individual’s guardian or representative, and any
other person chosen by the individual within 15 business days of the selection of
and acceptance by, a service coordination agency.
(f) The service coordinator shall document that they
have maximized the extent to which an individual participates in and directs their
person-centered service planning process by:
(1) Explaining to the individual the
person-centered service planning process and providing the information and support necessary to ensure that the
individual directs the process to the maximum extent possible;
(2) Explaining
to the individual their rights and responsibilities pursuant to He-M 310;
(3) Eliciting information from the individual
regarding their goals, personal preferences, and service needs, including any health concerns, that shall be
a focus of person-centered service planning meetings;
(4) Determining
with the individual issues to be discussed during all person-centered service
planning meetings; and
(5) Explaining
to the individual the limits of the decision-making authority of the guardian,
if applicable, and the individual’s right to make all other decisions related
to services.
(g) The person-centered service planning process
shall include a discussion regarding whether or not there is a need for a
limited or full guardianship, conservatorship, representative payee for social security
benefits, durable power of attorney, durable power of attorney for healthcare,
supported-decision making, or other less restrictive alternatives to
guardianship. The discussion and any recommendations from the team shall be
incorporated into the service agreement.
(h) Service
coordinators shall facilitate service planning to develop service agreements in
accordance with He-M 503.10. Service agreements shall be prepared
initially according to the timeframe specified in He-M 503.10 (c) and annually
thereafter, as required by He-M 503.08 (b)(10).
(i) The individual, guardian, or representative
may determine the following elements of the person-centered service planning process:
(1) The number
and length of meetings;
(2) The location,
date, and time of meetings;
(3) The meeting
participants; and
(4) Topics to be discussed.
(j) Copies
of relevant evaluations and reports shall be sent to the individual and
guardian at least 5 business days before person-centered service planning meetings.
(k) If
people who provide services to the individual are not selected by the
individual to participate in a person-centered service planning meeting, and
the individual determines that the provider would have information beneficial
to service planning, the service coordinator shall contact such persons prior
to the meeting so that their input can be considered.
(l) The
service coordinator shall contact all persons who have been identified to
provide a service to the individual and confirm arrangements for providing such
services.
(m) All
service planning shall occur through a person-centered service planning process
that:
(1) Maximizes
the decision-making of the individual;
(2) Is
directed by the individual or the individual’s guardian or representative, if
applicable;
(3) Facilitates
personal choice by providing information and support to assist the individual
to direct the process, including information describing:
a. The array
of services and provider agencies available; and
b. Options regarding self-direction of services;
(4) Includes
participants freely chosen by the individual;
(5) Reflects
cultural considerations of the individual and is conducted in clearly
understandable language and form;
(6) Occurs
at times and a location of convenience to the individual, guardian, or
representative;
(7) Includes
strategies for solving conflict or disagreement within the process, including
clear conflict of interest guidelines for all planning participants;
(8) Is
consistent with an individual’s rights to privacy, dignity, respect, and
freedom from coercion and restraint;
(9) Includes
the process for the individual, guardian, or representative to request
amendments to the service agreement;
(10) Records
the alternative home- and community-based settings that were considered by the
individual, guardian, or representative;
(11) Includes
information related to risk by:
a. Incorporating
information obtained through a comprehensive risk assessment, which shall be administered:
1. Initially,
at the beginning of service planning, or as needed to each individual with a
history of, or exhibiting signs of, behaviors that pose a potentially
serious likelihood of danger to self or others, or a serious threat of
substantial damage to real property, such as, but not limited to, the
following:
(i) Problematic sexual behavior;
(ii) Violent aggression;
(iii) Fire-setting behaviors; or
(iv) Other similar violent
or dangerous behaviors or events;
2. Prior
to any significant change in the level of the individual’s treatment or supervision;
3. At
any time an individual who previously has not had a comprehensive risk
assessment begins to engage in behaviors referenced in 1. above; and
4. By
an evaluator with specialized experience, training, and expertise in the
treatment of the types of behaviors referenced in 1. above;
b. Ensuring
that plans created pursuant to He-M 505 are reviewed with evaluators to consider
ongoing appropriateness and opportunities for modification of restrictions
following initiation of risk management related strategies. Such considerations may be made
through reassessment or through a consultative review of other documentation
and updated data related to the individual’s progress;
c. Ensuring
documentation of activities and progress in treatment relative to management of
risk for an individual to help inform development of person-centered service
plans;
d. Making referrals for individuals associated with high-risk incidents to participate in
evaluations or planning activities initially and ongoing;
e. Processing
and analyzing incidents related to violent aggression, problematic sexual
behavior, or fire-setting behaviors; and
f.
Making referrals for individuals associated with high-risk incidents to
evaluations or planning activities initially and ongoing;
(12) Includes
information from specialty medical and health assessments and clinical
assessments as needed, including, at a minimum, communication, assistive
technology, and functional behavior assessments, as applicable;
(13) Includes
strategies to address co-occurring severe mental illness or behavioral
challenges which are interfering with the person’s functioning, including
positive behavior plans or other strategies based on functional behavior or
other evaluations or referrals to behavioral health services;
(14) Provides the individual with information regarding
the services and provider agencies available to enable the individual to make
informed decisions as to whom they would like to provide services;
(15) Includes
individualized backup plans and strategies;
(16) Includes
strategies for solving disagreements;
(17) Uses
a strengths-based approach to identify the positive attributes of the individual;
(18)
Includes the provision of auxiliary aids and services when needed for effective
communication, including low literacy materials and interpreters;
(19) Addresses
the individual’s concerns about current or contemplated guardianship or other
legal assignment of rights;
(20) Explores
housing and employment in integrated settings, and develops plans consistent
with the individual’s goals and preferences;
(21) Includes
a review of the past year that:
a. Includes the individual’s:
1. Personal
achievements;
2. Relationships;
3. Degree
of community involvement;
4. Challenging
issues or behavior;
5. Health
status and any changes in health; and
6. Safety
considerations during the year;
b. Addresses
the previous year’s goals with level of success and, if applicable, identifies
any obstacles encountered;
c. Identifies the individual’s personal goals and the supports that will
aid in achieving their goals;
d. Identifies
the type and amount of services the individual receives and the support
services provided under each service category;
e. Identifies the individual’s health needs;
f. Identifies the individual’s safety needs;
g. Identifies
any follow-up action needed on concerns and the persons responsible for the
follow-up; and
h. Includes a statement of the individual’s and guardian’s
satisfaction with services;
(22) Includes
the individual’s paid employment and volunteer positions, as applicable;
(23) Considers
historical information about the individual’s experiences; and
(24) Includes a discussion of the need for assistive
technology that could be utilized to support all services and activities
identified in the proposed service agreement without regard to the individual’s
current use of assistive technology.
(n) The information outlined in (m)(1)-(24) above
shall be entered into the service agreement outlined in He-M 503.10 when the
individual, guardian, or planning team determine that such information is
necessary for successful participation in the services and supports outlined in
the service agreement.
(o) All planning for home and community-based
waiver services shall include information from the following assessments:
(1) The American Association on Intellectual and
Developmental Disabilities’, “SIS-A ®”, (2023 edition), available as noted in
Appendix A, for individuals aged 16 or older, which shall be administered:
a. Initially, within 60 days of the
determination of eligibility for waiver services pursuant to He-M 503.05(o) for each individual;
b. For individual’s receiving In Home Supports home
and community-based waiver services within 60 days of
when the individual reaches age 16;
c. Upon a significant
change as defined under SIS-A ® protocols;
d. Five years following
each prior administration; and
e. To individuals who have moved to New Hampshire
and are requesting home and community-based waiver services
in the next 12 months. If the individual has previously had a SIS-A ® completed in another state within the
last 5 years, however, then they may provide the out-of-state SIS-A ® results
in place of taking a new SIS-A ®; and
(2) Information obtained through the HRST (2015
edition), available as noted in Appendix A, which shall be administered:
a. Initially, upon
determination of eligibility for waiver services pursuant to He-M 503.05(o) or He-M
524 for each individual; and
b. Annually or upon
significant change in an individual’s status; and
(3) For residential services, includes information
from personal safety assessments pursuant to He-M 1001.
(p) In
order to develop or revise a service agreement to the satisfaction of the
individual, guardian, or representative, the person-centered service planning
process shall consist of periodic and ongoing discussions regarding elements
identified in He-M 503.07(b) that:
(1) Include
the individual and other persons involved in their life;
(2) Are
facilitated by a service coordinator; and
(3) Are
focused on the individual’s abilities, health, interests, and achievements.
(q) Service
agreements shall be reviewed by the service coordinator with the individual,
guardian, or representative at least once during the first 6 months of service
and as needed. The annual review required by He-M 503.08 (b)(10)
shall include a service planning meeting.
(r) Pursuant
to RSA 171-A:11, the reviews required in (q) above shall include, at a minimum,
the following:
(1) A
thorough clinical examination including an annual health assessment;
(2) An
assessment of the individual’s capacity to make informed decisions; and
(3) Consideration
of less restrictive alternatives for service.
(s) The
individual, guardian, or representative may request, in writing, a delay in an
initial or annual service agreement planning meeting. The area agency and
provider agencies shall honor this request.
(t) In the event an individual, guardian, or
representative requests an extension of the service agreement meeting, the extension
shall be documented and not exceed 60 days after the expiration of the current
service agreement.
(u) The
service coordinator shall be responsible for monitoring services identified in
the service agreement pursuant to He-M 503.10(l) and for assessing individual,
family, or guardian satisfaction at least annually for non-waiver services and
quarterly for waiver services.
(v) If an individual has a residency agreement and
there is notification of intended termination, the service coordinator shall
convene a person-centered service planning meeting as follows:
(1) Within 10 days of receipt of notification of
the intended termination; or
(2) Within 24 hours of receipt of the
notification if the intended termination is within 72 hours due to the threat
of serious bodily injury by or to the resident.
(w) An
area agency, service coordinator, provider agency, provider, individual,
guardian, or representative shall have the authority to request a person-centered
service planning meeting at any time.
(x) Service
agreement amendments may be proposed at any time.
(y) If
the individual, guardian, or provider agency disapproves of the service
agreement, or a service agreement amendment, the dispute shall be resolved:
(1) Through
informal discussions between the individual, guardian, or representative and
service coordinator;
(2) By
reconvening a person-centered service planning meeting; or
(3) By
the individual, guardian, or representative filing an appeal to the bureau
pursuant to He-C 200.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(from He-M 503.10); ss by #13841, eff 12-29-23
He-M
503.10 Service Agreements.
(a) The
service coordinator shall create service agreements for all individuals in
accordance with (b)-(f) below.
(b) All
service agreements shall:
(1) Be
understandable to the individual, guardian, or representative and all provider
agencies and providers responsible for service provision;
(2) At
a minimum, be written in plain language and in a manner accessible to
individuals with disabilities and persons who have limited proficiency in
English;
(3) Be
finalized and agreed to in writing by the individual, guardian, or
representative and signed by all provider agencies responsible for the
implementation of the service agreement;
(4) Be
entered into the electronic platform, IntellectAbility at https://nhbds.hrstapp.com/ , and
then NH Easy at https://nheasy.nh.gov/#/ , when IntellectAbility sunsets; and
(5) Be
distributed to the individual, guardian or representative, area agency, and all
provider agencies and providers who are responsible for the implementation or monitoring
of the service agreement.
(c) Within
14 days of the initial person-centered service planning meeting pursuant to
He-M 503.09 (e), the service coordinator shall develop a service agreement that
includes, but is not limited to, the following:
(1) A statement of the nature of the specific
strengths, interests, capacities, disabilities, and specific needs of the individual;
(2) A description of intermediate and long-range
habilitation and treatment goals chosen by the individual and their guardian
with a projected timetable for their attainment;
(3) A statement of specific services to be
provided and the amount, scope, frequency, and duration of each service;
(4) Specification of the provider agencies to
furnish each service identified in the service agreement;
(5) Criteria for transfer to less restrictive
settings for habilitation, including criteria for termination of service, and a
projected date for termination of service;
(6) Demographic information;
(7) A personal profile;
(8) The
specific services to be furnished based on the support needs identified in (1)
above and how the services selected will support the individual’s goals;
(9) Guardianship,
supported decision-making, and representative payee information;
(10) Service
documentation requirements sufficient to track outcomes;
(11) Identification
of the persons and entities responsible for monitoring the services in the service
agreement;
(12) Documentation
that all settings where the individual receives services meet the criteria of 42
CFR 441.301, are chosen by the individual or representative, and support full
access to the greater community, including opportunities to seek employment and
work in competitive integrated settings, engage in community life, control
personal resources, and receive services in the community to the same degree of
access as people not receiving services;
(13) Documentation
that the setting is selected by the individual from among setting options,
including non-disability specific settings and an option for a private unit in
a residential setting, and that the settings options are identified and based
on the individual’s needs, and preferences;
(14) Documentation
that any restriction on the right of an individual is justified by:
a. An identified specific and individualized need that the modification is
based on;
b. The positive
interventions and supports used prior to any modifications to the individual’s
rights;
c. The less
intrusive methods of meeting the need that were tried but did not work;
d. A clear description of the condition that is directly proportionate to the
specific assessed need;
e. The regular collection and review of data to measure the ongoing
effectiveness of the modification;
f. Established time limits for periodic reviews of the necessity of the
modification;
g. The informed consent of the individual, guardian, or representative;
and
h. An assurance that the modification will not cause harm to the
individual;
(15) Services needed but not currently available;
and
(16) If applicable, risk factors and the measures
required to be in place to minimize them, including backup plans and
strategies.
(d) For
individuals receiving waiver services, the information provided below shall be
added to the service agreement:
(1) The
specific waiver services to be provided including the amount, scope, frequency,
and duration;
(2) The results of the SIS-A ® and the HRST;
(3) Service
documentation requirements sufficient to describe progress on goals and the services
received; and
(4) If
applicable, reporting mechanisms under self-directed services regarding budget
updates and individual and guardian satisfaction with services.
(e) For
individuals who reside in a provider owned or controlled residential setting,
the service agreement shall document any modifications of the individual’s
rights in said setting to:
(1) Privacy
in their sleeping or living unit, including doors lockable by the individual
with only appropriate providers having keys to doors as needed;
(2) Freedom
and support to control their own schedule and activities;
(3) Access
to food at any time;
(4) Having
visitors of their choosing at any time; and
(5) Freedom
to furnish and decorate sleeping or living units.
(f) A
provider agency shall only make modifications pursuant to (e) above by
documenting in the service agreement the following:
(1) An
identified specific and individualized assessed need that the modifications are
based on;
(2) The
positive interventions and supports used prior to any modifications to the
service agreement;
(3) The
less intrusive methods of meeting the need that have been tried but did not
work;
(4) A
clear description of the condition that is directly proportionate to the
specific assessed need;
(5) The
regular collection and review of data to measure the ongoing effectiveness of
the modification;
(6) Established
time limits for periodic reviews to determine if the modification is still
necessary or can be terminated;
(7) The
informed consent of the individual or representative; and
(8) An
assurance that the interventions and support will not cause harm to the
individual.
(g) Within
5 business days of completion of a service agreement, or service agreement amendment,
the service coordinator shall provide the individual and guardian, or
representative the following:
(1)
The service agreement, signed by the service coordinator, and all provider
agencies identified in the service agreement;
(2) The
name, address, email, and phone number of all provider agencies; and
(3) A
description of the procedures for challenging the proposed service agreement
pursuant to He-M 503.16 for those situations where the individual, guardian, or
representative disapproves of the service agreement.
(h) The
individual, guardian, or representative shall have 10 business days from the
date of receipt of the service agreement, or the service agreement amendment,
to respond in writing, indicating approval or disapproval of the service
agreement or amendment. Unless otherwise arranged between the individual,
guardian, or representative and the service coordinator, failure to respond
within the time allowed shall constitute approval of the service agreement or
amendment.
(i) When
a service agreement has been approved by the individual, guardian, or
representative and service coordinator, the services shall be implemented and
monitored as follows:
(1) A
person responsible for implementing any part of a service agreement, shall
collect and record information about services provided and how they have
impacted progress on the individual’s goals, in a timeframe outlined in the
service agreement or, at a minimum, monthly;
(2) On
at least a monthly basis, the service coordinator shall visit or have verbal or
written contact, as determined by the individual or persons responsible for
implementing a service agreement, and document these contacts;
(3) The
service coordinator shall visit the individual and contact the guardian, if
any, at least quarterly, or more frequently if so specified in the individual’s
service agreement, to determine and document:
a. Whether services match the interests and needs of the individual;
b. Individual
and guardian satisfaction with services; and
c. Progress
on the goals in the expanded service agreement; and
(4) If
the individual receives services under He-M 1001, or residential services under
He-M 521, He-M 524, or He-M 525, all of the service coordinator’s quarterly
visits with the individual shall be in the home where the individual resides.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(from He-M 503.11); ss by #13841, eff 12-29-23
He-M
503.11 Record Requirements for Area Agencies and Provider Agencies.
(a) Area
agencies, service coordinators, and other provider agencies, or their designees
shall maintain a separate record for each individual who receives services and
ensure the confidentiality of information pertaining to the individual,
including:
(1) Maintaining
the confidentiality of any personal data in the records;
(2) Storing
and disposing of records in a manner that preserves confidentiality; and
(3) Obtaining
a release of information pursuant to He-M 503.04 (h) prior to release of any
part of a record to a third party.
(b) An
individual’s record shall include, as applicable:
(1) Personal
and identifying information including the individual’s:
a. Name;
b. Address;
c. Date of
birth; and
d. Telephone number;
(2) All
information used to determine eligibility for services pursuant to He-M 503.05
and He-M 503.06;
(3) Information
about the individual that would be essential in case of an emergency,
including:
a. Name,
address, and telephone number of legal guardian, representative, or next of kin
or other person to be notified;
b. Name, address, and telephone number of current providers; and
c. Medical information as applicable, including:
1. Diagnosis(es);
2. Health
history;
3. Allergies;
4. Do
not resuscitate (DNR) orders, as appropriate;
5. Advance
directives, as determined by the individual;
6. Current medications; and
7. Any correspondence related to medical information
relevant to the individual;
(4) A
copy of the individual’s current service agreement;
(5) Copies
of all service agreement amendments;
(6) Progress
notes on goals and support services provided as identified in the service
agreement;
(7) All
service coordination contact notes and quarterly assessments pursuant to He-M
503.10(i)(2)-(4);
(8) Copies
of evaluations and reviews by providers and professionals;
(9) Copies
of correspondence within the past year with the individual and guardian, area
agency, provider agencies, providers, physicians, attorneys, state and federal
agencies, family members, and others in the individual’s life;
(10) Other
correspondence or memoranda concerning any significant events in the
individual’s life;
(11) Information
about transfer or termination of services, as appropriate; and
(12) Proof that the individual was given choice of
provider agencies.
(c) All
entries made into an individual record shall be legible and dated and have the
author identified by name and position.
(d) In
addition to the documentation requirements identified in He-M 503, each area
agency, service coordinator, provider agency, and provider shall comply with
all applicable documentation requirements of other department rules.
(e) Each
billing entity shall:
(1) Retain
records supporting each Medicaid bill for a period of not less than 6 years;
and
(2)
Retain an individual’s social history, medical history, evaluations, and any
court-related documentation for a period of not less than 6 years after
termination of services.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(from He-M 503.12); ss by #13841, eff 12-29-23
He-M
503.12 Service Funding.
(a) Pursuant
to RSA 171-A:1-a, I, services shall be funded in such a manner that:
(1) For
individuals in school and already eligible for services from the area agencies,
funds shall be allocated to them 90 days prior to their graduating or exiting
the school system or earlier so that any new or modified services needed are
available and provided upon such school graduation or exit;
(2) For
newly found eligible adults, the period between the time of completion of a
service agreement and the allocation by the department of the funds needed to
carry out the services required by the service agreement shall not exceed 90
days; and
(3) For
individuals already receiving services who experience significant life changes,
such as a significant change in their medical conditions, the period of time
for initiation of new services shall not exceed 90 days from the amendment of
the service agreement except by mutual agreement between the area agency and
the individual specifying a time limited extension.
(b) Service
funding needs for (a)(1)-(2) shall be documented by the area agency into NH
Easy at
https://nheasy.nh.gov/#/.
(c) Service funding needs for (a)(3) shall be documented by the
service coordinator into NH Easy at https://nheasy.nh.gov/#/.
(d)
The bureau shall make the final determination on the cost effectiveness of
proposed services for all funding requests.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(from He-M 503.14); amd by #12948, eff 12-20-19; ss by #13841, eff 12-29-23
He-M
503.13 Transfers Across Regions.
(a) If
an individual, guardian, or representative plans to relocate where
the individual lives and wishes to transfer
the individual’s area agency affiliation to that region, the
individual, guardian, or representative shall notify, in writing, the area agency
in the current region and the area agency in the proposed region that the
individual is moving and wishes to transfer services to that region.
(b) The
current area agency shall send to the proposed area agency all information contained
within the individual’s file as outlined in He-M 503.11.
(c) Service
coordinators shall assist with the coordination when an individual transfers so
that benefits obtained from third party resources such as Medicaid, community
mental health center services, and the division of vocational rehabilitation services
shall not be lost or delayed during the transition from one region to another.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New.
#6932, eff 1-27-99; ss by #8805, eff 1-27-07; ss by #10372, eff 7-1-13;
ss by #10900, eff 7-25-15 (from He-M 503.15); ss by #13841, eff 12-29-23
(formerly He-M 503.14)
He-M
503.14 Termination of Services.
(a) If
termination of services is being considered by the area agency, service
coordinator, individual, guardian, representative, or provider agency, then the
service coordinator shall meet with either the individual or their guardian or
representative, or both to discuss the reasons for the recommended termination.
(b) Any
recommendation for termination shall be made in writing to the area agency
director and be based on one or both of the following:
(1) The
individual can function without such service; or
(2) Services
are no longer necessary because they have been replaced by other supports or
services.
(c) Within
10 business days of receipt of a recommendation for termination of services, an
area agency director shall call a meeting with the service coordinator, either
the individual or their guardian or representative, if applicable, and the
provider agencies to be convened to review the request. The purpose of the
meeting shall be to determine if the criteria listed in (b) above applies to
the individual.
(d) Based
on the information presented and determinations made at the meeting, the
service coordinator shall prepare a written report for the area agency director
which sets forth one of the following:
(1) A
statement of concurrence with the recommendation for termination;
(2) A
recommendation for continuance; or
(3) Changes
to the individual’s service agreement.
(e) The
area agency director shall make the final decision regarding termination based
on the criteria listed in (b) above.
(f) If
a decision is made to terminate services pursuant to (b) above, the area agency
director shall send a termination notice to the individual, guardian, or
representative at least 30 days prior to the proposed termination
date. Services may be terminated sooner than 30 days with the consent of
the individual, guardian, or representative. The individual,
guardian, or representative may appeal the termination decision in accordance
with He-C 200.
(g) In
each termination notice the area agency shall provide information on the reason
for termination, the right to appeal, and the process for appealing the
decision, including the names, addresses, and phone numbers of the office of
client and legal services of the bureau and advocacy organizations, such as the
Disability Rights Center-NH, which the individual, guardian, or representative
may contact for assistance in appealing the decision.
(h) An
individual whose services have been terminated may request resumption of
services if they believe that the
reasons for the termination of services no longer apply. Such a
request shall be made by the individual, guardian, or representative, in
writing, to the area agency director.
(i) Upon
request of the individual, guardian, or representative, the area agency
director shall resume services to the individual if the criteria in (b) above
no longer apply and if funding is available.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07;
ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(from He-M 503.16); ss by #13841, eff 12-29-23 (formerly He-M 503.15)
He-M
503.15 Voluntary Withdrawal from Services.
(a) An
individual, guardian, or representative may withdraw voluntarily from any
service(s) at any time, except as provided by RSA 171-B.
(b) The
administrator of the service from which withdrawal is made shall notify the
area agency in writing of the withdrawal and so indicate in the individual’s
record.
(c) If
any provider determines that withdrawal from a service might constitute abuse,
neglect, or exploitation on the part of a guardian or representative, the provider
or service coordinator shall report such abuse, neglect, or exploitation as
required by law.
(d) If
an individual does not have a guardian or representative and their service
coordinator or any other person believes that the individual is not making an
informed decision to withdraw from services and might suffer harm as a result
of abuse, neglect, or exploitation, the area agency shall pursue the least
restrictive protective means including, as appropriate, guardianship to address
the situation.
(e) An
individual who has withdrawn from services may request resumption of services
at any time. Such a request shall be made by the individual,
guardian, or representative, in writing, to the area agency director.
(f) Upon
request of the individual, guardian, or representative, the area agency
director shall resume services to the individual if funding is available.
Source. #1969, eff 2-25-82; ss by #2615, eff 2-6-84;
ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED:
8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07
(from
He-M 503.13); ss by #10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by
#10900, eff 7-25-15 (from He-M 503.17); ss by #13841, eff 12-29-23 (formerly He-M 503.16)
He-M
503.16 Challenges and Appeals.
(a) Any
determination, action, or inaction by the bureau, a service coordination
agency, provider agency, or area agency may be appealed by an individual,
guardian, or representative.
(b) An
individual, guardian, or representative may choose to pursue formal or informal
resolution to resolve any disagreement with the bureau, a service coordination
agency, provider agency, or an area agency. If informal resolution
is sought, at any time during the process or within 30 business days of the bureau,
service coordination agency, provider agency, or area agency decision, the
individual may choose to file a formal appeal pursuant to (e)-(g)
below. All formal appeals shall be filed within 30 days of the
bureau, area agency, provider agency, or service coordination agency determination,
action, or inaction.
(c) The
following actions shall be subject to the notification requirements of (d)
below:
(1) Adverse
eligibility actions under He-M 503.05(i) and (q) and He-M 503.06(e) and (f);
(2)
Proposed service agreements or service agreement amendments if the individual,
guardian, or representative disapproves pursuant to He-M 503.10(h); and
(3) A
determination to terminate services under He-M 503.14(f).
(d) The
bureau, area agency, provider agency, or service coordination agency, as
applicable, shall provide written notice to the applicant, individual, and
guardian or representative of the actions specified in (c) above, including:
(1) The
specific rules that support, or the federal or state law that requires, the
action;
(2) Notice
of the individual’s right to appeal in accordance with He-C 200 within 30
business days and the process for filing an appeal, including the contact
information to initiate the appeal with the bureau’s administrator;
(3) Notice
of the individual’s continued right to services pending appeal, when
applicable, pursuant to (g) below;
(4) Notice
of the right to have representation with an appeal by:
a. Legal counsel;
b. A relative;
c. A friend; or
d. Another spokesperson;
(5) Notice
that neither the area agency, provider agency, service coordination agency, nor
the bureau is responsible for the cost of representation; and
(6) Notice
of organizations with their addresses and phone numbers that might be available
to provide pro bono or reduced fee legal assistance and advocacy, including the
Disability Rights Center-NH.
(e) Appeals
shall be forwarded, in writing, to the bureau administrator in care of the
department’s office of client and legal services. An exception shall be
that appeals may be filed verbally if the individual is unable to convey the
appeal in writing.
(f) The
bureau administrator shall immediately forward the appeal to the department’s
administrative appeals unit which shall assign a presiding officer to conduct a
hearing, as provided in He-C 200. The burden shall be as provided by
He-C 204.12.
(g) If
a hearing is requested, the following actions shall occur:
(1) For
current recipients, services and payments shall be continued as a consequence
of an appeal for a hearing until a decision has been made; and
(2) If
the bureau, service coordination agency, provider agency, or area agency decision
is upheld:
a. Benefits
shall cease 60 days from the date of the denial letter or 30 days from the
hearing decision, whichever is later; or
b. In the
instance of termination of services, services shall cease one year after the
initial decision to terminate services or 30 days from the hearing decision, whichever
is later.
Source. #8805, eff 1-27-07 (from He-M 503.14); ss by
#10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15 (from
He-M 503.18); ss by #13841, eff 12-29-23 (formerly He-M 503.17)
He-M
503.17 Waivers.
(a) An
applicant, area agency, service coordination agency, provider agency,
individual, guardian, representative, or provider may request
a waiver of specific procedures outlined in He-M 503 by completing and
submitting the form titled “NH Bureau of Developmental Services Waiver Request”
(October 2023). The request shall be sent in writing to the bureau
administrator.
(b) A
completed waiver request form shall be signed by:
(1) The
individual, guardian, or representative indicating agreement with the request;
and
(2) If
applicable, the area agency, service coordination agency, or provider agency’s executive
director or designee recommending approval of the waiver.
(c) A
waiver request shall be submitted to the department via:
(1) Email at bds@dhhs.nh.gov; or
(2) By mail to:
Bureau of
Developmental Services
Hugh J. Gallen State Office
Park
105 Pleasant Street, Main Building
Concord, NH 03301
(d) No
provision or procedure prescribed by statute shall be waived.
(e) The
request for a waiver shall be granted by the commissioner or their designee
within 30 days if the alternative proposed by the requesting entity meets the
objective or intent of the rule and it:
(1) Does
not negatively impact the health or safety of the individual(s); and
(2) Does
not affect the quality of services to individuals.
(f) Upon
receipt of approval of a waiver request, the requesting entity’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(g) Waivers
shall be granted in writing for the minimum period necessary to accommodate the
waiver request, with a specific duration not to exceed 5 years except as in
(h)-(i) below.
(h) Any
waiver shall end with the closure of the related program or service.
(i) A
requesting entity may request a renewal of a waiver from the
bureau. Such request shall be made at least 30 days prior to the
expiration of a current waiver.
Source. #8805, eff 1-27-07 (from He-M 503.15); ss by
#10774, INTERIM, eff 1-27-15, EXPIRES: 7-27-15; ss by #10900, eff 7-25-15
(formerly He-M 503.19); ss by #13841, eff 12-29-23(formerly He-M 503.18)
PART He-M 504 PROVIDER AND PROVIDER AGENCY OPERATIONS
Statutory
Authority: RSA 171-A:3, 18, IV
REVISION NOTE:
Document
#13679, effective 6-28-23, adopted He-M 504 as an emergency rule, and the “NH
Bureau of Developmental Services Waiver Request” form (July 2019) was incorporated
by reference in He-M 504.14(a). Document
#13788, effective 10-21-23, readopted the form with amendments pursuant to the
expedited revisions to agency forms process in RSA 541-A:19-c, updating the
revision date of the form from July 2019 to October 2023. Document #13788 contained only the updated form,
giving the form a new effective date, while leaving the effective date of the
rule He-M 504.14 under Document #13679 as 6-28-23.
The
emergency rule in Document #13679 would normally have expired 12-25-23, but before
the rule expired, Document #13807, effective 11-17-23, readopted with amendment
He-M 504, including the “NH Bureau of Developmental Services Waiver Request” form
incorporated by reference with a revision date of October 2023 in He-M 504.14(a).
He-M 504.01 Purpose. The purpose of these rules is to define the
expectations for all providers and provider agencies seeking payment from the department
for the provision of authorized services to eligible individuals with
developmental disabilities and acquired brain disorders.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.02 Definitions. The words and phrases used in these rules
shall mean the following, except where a different meaning is clearly intended
from the context:
(a)
“Acquired brain disorder” means a disruption
in brain functioning that:
(1) Is
not congenital or caused by birth trauma;
(2) Presents a severe and life-long disabling condition which significantly
impairs a person’s ability to function in
society;
(3) Occurs
prior to age 60;
(4) Is attributable to one or
more of the following reasons:
a. External trauma to the brain as a result of:
1. A
motor vehicle incident;
2. A
fall;
3. An
assault; or
4. Another
related traumatic incident or occurrence;
b. Anoxic or hypoxic injury to the brain such as from:
1. Cardiopulmonary
arrest;
2. Carbon
monoxide poisoning;
3. Airway
obstruction;
4. Hemorrhage;
or
5. Near
drowning;
c. Infectious diseases such as encephalitis and meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic
exposure; or
h. Other
neurological disorders such as Huntington’s disease or multiple sclerosis which
predominantly affect the central nervous system resulting in diminished
cognitive functioning and ability; and
(5) Is
manifested by one or more of the following:
a. Significant decline in cognitive functioning and ability; or
b. Deterioration in:
1. Personality;
2. Impulse
control;
3. Judgment;
4. Modulation
of mood; or
5. Awareness
of deficits;
(b) "Area agency" means “area agency”
as defined in RSA 171-A:2, I-b.
(c)
“Bureau” means the bureau of developmental services of the department of
health and human services;
(d)
“Commissioner” means the commissioner of the department of health and human
services or designee;
(e) “Cost of care” means the amount of income that
eligible individuals receiving home and community based waiver services are
liable to contribute toward the cost of their services as specified in He-M 517;
(f)
“Critical incident” means an
alleged, suspected, or actual occurrence of:
(1) Abuse including physical, sexual, verbal, and
psychological abuse;
(2) Neglect;
(3) Exploitation;
(4) Serious injury;
(5) Death other than by natural causes; and
(6) Other events that threaten the health or
safety of an individual such as hospitalizations, administration of the wrong
medication, failure to administer medication, or use of restraints or behavioral
interventions that are not included in an approved behavior change program;
(g) “Days” means calendar days unless otherwise
specified;
(h) “Department” means the New Hampshire department of health and human
services;
(i)
"Developmental disability" means “developmental disability” as
defined in RSA 171-A:2, V, namely, "a disability:
(1) Which is attributable to an intellectual
disability, cerebral palsy, epilepsy, autism, or a specific learning disability,
or any other condition of an individual found to be closely related to an
intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability; and
(2) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual's ability to function
normally in society.";
(j)
“Enrolled provider” means a provider agency or independent provider that
the department has determined is eligible to provide Home and Community Based 1915
(c) waiver services and receive payment therefore;
(k)
“Guardian” means a person appointed pursuant to RSA 463 or RSA 464-A or
the parent of an individual under the age of 18 whose parental rights have not
been terminated or limited by law;
(l)
“Home and community based waiver services” means the services defined
and funded pursuant to New Hampshire’s agreement with the federal government,
known as the Developmental Disabilities Waiver, In-Home Supports Waiver, and
the Acquired Brain Disorder Waiver, pursuant to the authority section of
1915(c) of the Social Security Act which allows the federal funding of
long-term care services in non-institutional settings for persons who are
developmentally disabled or who have an acquired brain disorder;
(m)
“Individual” means a person who has a developmental disability or
acquired brain disorder;
(n) “Medicaid” means the Title XIX and Title XXI programs administered
by the department, which makes medical assistance and services available to
eligible individuals;
(o) “Medicaid management information system
(MMIS)” means the general system for mechanized
claims processing and information retrieval recommended by the Centers for
Medicare and Medicaid Services (CMS) for the implementation of the requirements
of state fiscal administration pursuant to 42 CFR 433, Subpart C;
(p)
“Organized health care delivery system (OHCDS)”
means an
area agency, designated pursuant to He-M 505, that directly provides at least one
home and community based waiver service;
(q)
“Pass-through billing” means an arrangement, pursuant to 42 CFR
447.10(g)(3), whereby the OHCDS is the enrolled provider of home and community
based waiver services for the purposes of billing and subcontracting for the
service provision and has authorization from the department to do so;
(r)
“Person-centered service planning” is an individual-directed, positive
approach to the planning and coordination of a person’s services and other
supports based on the individual’s aspirations, needs, preferences, and goals;
(s)
“Problematic sexual behavior” means non-consensual touching or attempting to
touch another person’s body in a sexualized manner, unsolicited sexualized
statements, public exposure, and illegal sexual conduct whether in person or online.
(t)
“Provider” means a person receiving any form of remuneration for the
provision of services to an individual;
(u)
“Provider agency” means an agency or an independent provider that is established
to provide services to individuals;
(v) “Provider
applicant” means a provider agency who is undergoing the enrollment or
re-enrollment process to become a New Hampshire Medicaid provider;
(w) “Provider enrollment ID” means a unique
identification number assigned to provider agencies who are enrolled in the
state’s Medicaid program and authorized to provide services to Medicaid
beneficiaries;
(x) “Room and board” means shelter
type expenses, including all property-related costs such as rental or purchase
of real estate and furnishings, maintenance, utilities, and related
administrative services, and 3 meals a day or any other full nutritional
regimen;
(y)
“Sentinel event” means an unexpected occurrence involving death or
serious physical or psychological injury, or risk thereof. Serious injury
specifically includes loss of limb or function. Categories of reportable
sentinel events are individual-centered events, in which the individual is
either a victim or perpetrator, including, but are not limited to:
(1) Any sudden, unanticipated, or accidental
death, not including homicide or suicide, and not related to the natural course
of an individual’s illness or underlying condition;
(2) Permanent loss of function, not related to
the natural course of an individual’s illness or underlying condition,
resulting from such causes including but not limited to:
a. A medication error;
b. An unauthorized departure or abduction from a
facility providing care; or
c. A delay or failure to
provide requested or medically necessary services due to waitlists,
availability, insurance coverage, or resource limits;
(3) Homicide;
(4) Suicide;
(5) Suicide attempt, such as
self-injurious behavior with a non-fatal outcome, with explicit or implicit
evidence that the person intended to die and medical intervention was needed;
(6) Rape or any other sexual
assault;
(7) Serious physical injury;
(8) Serious psychological
injury that jeopardizes the person’s health that is associated with the
planning and delivery of care; or
(9) Injuries due to physical or
mechanical restraints;
(10) High profile or high risk event, such as:
a. Media coverage; or
b. Police involvement leading to an arrest;
(z)
“Service” means any paid assistance to an individual in meeting their
own needs provided through the developmental services system;
(aa)
“Service coordinator” means a provider who meets the criteria in He-M
503 or He-M 522 and is chosen by an individual and their guardian or
representative to organize, facilitate, and document service planning and to
negotiate and monitor the provision of the individual’s services;
(ab)
“Service coordination agency” means a provider agency providing service
coordination services to individuals and licensed pursuant to He-P 819;
(ac)
“Staff” means a person employed by a provider agency, subcontract agency,
or other employer; and
(ad) “Utilization
review and control” means the monitoring of medicaid program services
pursuant to 42 CFR 455 and 42 CFR 456.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.03 Roles and Responsibilities of Providers
and Provider Agencies.
(a)
All provider agencies shall obtain and maintain certifications for
community residences, enhanced family care shared living residential
habilitation services, and adult day community participation services in
accordance with He-M 507 or He-M 1001, as applicable.
(b) All providers and provider agencies shall be
responsible for the following:
(1) Participating in person-centered service
planning in accordance with He-M 503, He-M 522, and He-M 524;
(2) Ensuring service delivery is led by the individual
and family, if chosen by the individual, and promotes community involvement, relationship
development, independence, societal contribution, enhancement of individual
communications, and aligns with an individual’s service agreement and in
accordance with RSA 171-A;
(3) Reviewing the service agreement to ensure:
a. That all provider agencies review and sign
the service agreement in accordance with He-M 503, He-M 522, and He-M 524, as
applicable, to indicate that they agree to provide services in the amount,
scope, frequency and duration, as outlined; and
b. That all
providers review the service agreement relative to the service that they will
be providing prior to service provision;
(4) Ensuring that all services and supports are
provided in accordance with He-M 310, He-M 503, He-M 517, He-M 522, He-M 524,
and He-M 1201, as applicable;
(5) Creating and maintaining documentation in
accordance with He-M 503, He-M 517, He-M 522, He-M 524, and He-M 1201, as
applicable;
(6) Providing documentation of service planning,
monitoring, and billing related to the service being provided, within 30 days
of the request from the following entities, unless otherwise stated in rule, as
follows:
a. To the department;
b. To area agencies, regarding information that is
necessary for area agencies to complete their responsibilities pursuant to He-M
505; and
c. To service coordinators, regarding information
that is necessary for the service coordination provider agency and service
coordinator to complete their responsibilities pursuant to He-M 500;
(7) Providing documentation in (6) above within 3
business days in circumstances when the information is needed to support crisis
planning;
(8) Participating
in activities with the area agency that are necessary to complete its
responsibilities pursuant to He-M 505;
(9) Participating
in crisis mitigation and management which includes, but is not limited to,
identifying alternative placement options, sharing information with other
provider agencies and providers, and participating in crisis management
meetings;
(10) Documenting and submitting to service
coordination agencies and notifying guardians, if applicable, incident reports
regarding critical incidents;
(11) Documenting and submitting to area agencies incident
reports regarding critical incidents when the service coordination agency is
the reporting entity; and
(12) Managing responses to areas of risk, in
accordance with He-M 503, He-M 522, and He-M 524 and by:
a. Reviewing and
analyzing incidents related to violent aggression, problematic sexual behaviors,
or fire-setting behaviors as they pertain to service planning and provision;
b. Notifying
service coordinators of the presentation of incidents in accordance with (a)
above;
c. Presenting to committees and other groups
related to risk management, when invited by the service
coordinator, including, but not limited to, local human rights committees,
statewide and local risk management committees, and community of practice to
determine application of assessment recommendations received, when the provider
agency participated in the plan development;
d. Ensuring documentation of activities and
progress in treatment relative to management of risk for an individual to help inform the person-centered development
of plans;
e. Ensuring that agency personnel and contractors
receive clinically specialized trainings, based on assessed
needs of the individuals supported, that enable these personnel to successfully
complete risk management activities;
f. Ensuring participation
in risk management training activities; and
g. Ensuring that plans are reviewed regularly with
individuals and their treatment team to consider ongoing appropriateness and,
in the event that potential changes are indicated, seeking
additional consultation with providers qualified to conduct and author assessments,
whether they created the initial plans or are new, to discuss opportunities for
modification of restrictions by sharing data regarding the individual’s updated
progress in treatment.
(c) In addition to the requirements in He-M 504.03(b)(9)
for response to management of risk, service coordination provider agencies and
service coordination providers shall:
(1) Make referrals, as applicable, to the appropriate
area agency’s local risk management committee
for individuals exhibiting violent aggression, problematic sexual behaviors, or
fire-setting behaviors for evaluations or planning activities initially and
ongoing;
(2) Arrange for
assessments or evaluations resulting from local human rights committee
recommendations; and
(3) Participate in and present to committees and other
groups related to risk management including, but not limited to, local human
rights committees, statewide and local risk management committees and communities
of practice to determine application of assessment recommendations received.
(d) All service coordination agencies
shall document sentinel events and submit reports to the applicable area agency
for finalization in accordance with RSA 126-A:4.
(e) All provider agencies shall be
able to be contacted during their published hours of business, as indicated in the
medicaid provider enrollment process.
(f) In addition to (e) above, all home and
community based waiver community residence and enhanced family care shared
living residential habilitation provider agencies and service coordination provider
agencies shall be accessible 24/7 and have an on-call system for emergency
access outside of regular business hours to ensure response within 30 minutes
by a representative with decision-making authority.
(g) Each provider agency must complete a New
Hampshire criminal records check no more than 30 days prior to hire and prior
to working with any individual, and every other year thereafter, for all of its
providers, staff, contractors, and volunteers who will have direct contact with
individuals or families and:
(1) If the applicable provider, staff, contractor
or volunteer’s primary residence is out of state, a criminal records check for
their state of residence shall be completed prior to working with any
individual, and every other year thereafter; or
(2) If the applicable provider, staff, contractor
or volunteer has resided in New Hampshire for less than one year, a criminal
records check for their previous state(s) of residence shall be completed prior
to working with any individual.
(h) Each provider agency shall complete a check
of the division of children, youth and families (DCYF) state registry, pursuant to RSA 169-C:35 for all of its
providers, staff, contractors, and volunteers who will have direct contact with
individuals or families, prior to working with any individual and every other
year thereafter.
(i) Each provider agency shall complete a check
of the registry of founded reports of abuse, neglect, and exploitation pursuant to RSA 161-F:49 for all of its providers, staff,
contractors, and volunteers who will have direct contact with individuals and
families prior to working with any individual and every other year thereafter.
(j) Each provider agency shall obtain an
attestation from all of its providers, staff, contractors, and volunteers who will have direct contact with individuals or families in
the year in between the checks required pursuant to (g)-(i) above that they
have not:
(1) Been convicted of a felony or misdemeanor in
this or any other state; and
(2) Had a finding by the department or any
administrative agency in this or any other state for assault, fraud, abuse,
neglect, or exploitation of any person.
(k) Except
as allowed in (l) and (m) below, a provider agency shall not hire a person, or permit
them to volunteer:
(1) Who
has a:
a. Felony
conviction; or
b. Any
misdemeanor conviction involving:
1. Physical or
sexual assault;
2. Violence;
3. Exploitation;
4. Child pornography;
5. Threatening or
reckless conduct;
6. Theft;
7. Driving under
the influence of drugs or alcohol; or
8. Any other
conduct that represents evidence of behavior that could endanger the well-being
of an individual; or
(2) Whose
name is on either of the state registries of founded abuse, neglect, and
exploitation as established by RSA 161-F:49 and RSA 169-C:35.
(l) A provider
agency may hire a person, or permit the person to volunteer, with a criminal
record listed in (k)(1) a. or b. above for a single offense that occurred
10 or more years ago in accordance with (m) and (n) below. In such
instances, the individual, their guardian if applicable, and the provider
agency shall review the person’s history prior to approving the person’s
employment.
(m) Employment of a person pursuant to (l) above shall only occur if such
employment:
(1) Is
approved by the individual, their guardian, if applicable, and the provider agency;
(2) Does not
negatively impact the health or safety of the individual; and
(3) Does not
affect the quality of services to the individual.
(n) Upon hiring or permitting a person to volunteer
pursuant to (l) and (m) above, the provider agency shall document and retain
the following information in the individual’s record:
(1) The date(s)
of the approvals in (l) above;
(2) The
name of the individual for whom the person will provide services;
(3) The
name of the person hired or permitted to volunteer;
(4) Description of
the person’s criminal offense;
(5) The type of service the person is hired
or volunteering to provide;
(6) The provider agency’s name and address;
(7) A
full explanation of why the provider agency is hiring or allowing the person to
volunteer despite the person’s criminal record;
(8) Signature
of the individual, or of the legal guardian(s) if applicable, indicating
agreement
with the employment and date signed;
(9) Signature of the provider agency staff
person who obtained the individual or guardian’s signature and date signed;
(10) Signature of the provider agency’s executive
director or designee approving the
employment;
and
(11) The
signature and phone number of the person being hired or permitted to volunteer.
(o) In instances when obtaining the checks
required in (g)-(h) would delay a provider agency’s ability to have a provider, staff, contractor, or volunteer provide services, the
provider agency shall obtain a self-attestation from the prospective provider,
staff, contractor, or volunteer to attest that they have not:
(1) Committed a felony or misdemeanor in this or
any other state; and
(2) Had a finding by the department or any
administrative agency in this or any other state for assault, fraud, abuse,
neglect, or exploitation of any person.
(p) Self-attestations obtained in accordance with
(o) above shall be accepted while the provider agency is awaiting the results of the checks required in (g)-(h) above, but shall
not be valid for more than 90 days once signed. Individual and guardian
approval shall be obtained if a provider, staff, contractor or volunteer will work
directly with an individual and not under the supervision of a provider, staff,
contractor or volunteer with completed checks pursuant to (g)-(h) above.
(q) Each provider
agency shall check the office of the inspector general exclusion list prior to
hire and monthly thereafter with regard to checking names of prospective or
current providers, staff, and contractors.
(r) Each provider agency shall ensure all
providers, staff, contractors, and volunteers who drive individuals, in their
own vehicle or agency vehicle, have a valid driver’s license.
(s) Each provider agency, provider, staff, contractor,
and volunteer is a mandated reporter and shall report to the appropriate
department authority any individual who is suspected of being abused, neglected,
exploited, or self-neglecting, in accordance with, RSA 161-F:46 and RSA
169-C:35, and pursuant to He-M 202, any individual who is suspected of being
abused, neglected, exploited, or having had their service rights violated, in
accordance with He-M 310.
(t) Each provider agency
shall report instances of restraint and seclusion to each individual’s area
agency not less than quarterly.
(u) Provider agencies shall collect any applicable
room and board payments.
(v) Provider
agencies shall collect any applicable cost of care payments.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.04 Provider and Provider Agency Participation.
(a) Each
provider
agency who seeks to be enrolled to provide and receive reimbursement for home
and community based waiver services shall:
(1) Complete an application
for enrollment via the MMIS portal at: https://nhmmis.nh.gov/portals/wps/portal/ProviderLogin in order to apply to
be and operate as a New Hampshire Medicaid enrolled provider in
accordance with 42 CFR 455.410 and He-W 520.06, unless they choose to contract
with an OHCDS for pass-through billing, pursuant to He-M 504.06;
(2) Contact the bureau
to request a screening in accordance with (b) below:
a. Following initiation of an application in
accordance with (1) above; or
b. Not less than 120 days prior to expiration of
the current enrollment period when the provider agency intends
to submit an application for re-enrollment;
(3) Meet the applicable licensing, certification,
or other requirements of the specific service they provide, such as but not limited to, criteria required in New Hampshire
RSA 151, RSA 171-A, 42 CFR 441.301, or a contract with the bureau or OHCDS; and
(4) Have an executed Medicaid provider participation
agreement with the department in order to obtain Medicaid agency identification
numbers from the department for the specific services for which the provider agency
is enrolling.
(b) Each provider applicant shall participate in a
department screening upon enrollment and re-enrollment to review the following:
(1) Mission and vision statements, as applicable;
(2) Training practices, such as but not limited
to, requirements per specific position, purchased training platforms, and continuing
education hours requirements;
(3) Service-specific competencies, as related to developmental
services defined in chapter He-M 500;
(4) Three references that illustrate the provider applicant’s
ability to meet their service obligations in accordance with their mission and
vision statement;
(5) Financial indicators of fiscal integrity,
including but not limited to;
a. Financial statements identifying current
portion of long-term debt payments including principal and interest; and
b. A measure of total current assets available to
cover the cost of current liabilities;
(6) Liability protections;
(7) Policies and practices regarding restraint and
seclusion;
(8) Attestation that criminal background and
appropriate registry checks were completed pursuant to He-M 504.03(g)-(h); and
(9) Attestation that office of inspector general
checks were completed in accordance with He-M 504.03(n).
(c) The screening in (b) above shall occur within 90
days of application for enrollment and within 120 days for reenrollment.
(d)
A provider applicant shall not be enrolled pursuant to (a)(4) above until
the department has completed the screening in (b) above and has communicated this
to the department’s program integrity office.
(e) In addition to the reasons set forth in He-W
520.06, the department shall deny an application for provider agency enrollment
or re-enrollment, as applicable, due to any of the following reasons:
(1) Failure to
complete the screening required in (b) above;
(2) Any reported abuse, neglect, or exploitation
of an individual by an applicant, provider, provider agency, or contractor, if such
abuse, neglect, or exploitation is reported on the state registry of abuse,
neglect, and exploitation in accordance with RSA 161-F:49 or RSA 169-C:35 and
the provider agency failed to take appropriate action;
(3) A provider agency fails to ensure that its providers,
staff, and contractors meet the training requirements in chapter He-M 500, He-M
1001, He-M 1201, or Nur 404;
(4) A provider agency, provider, staff, or contractor
has an illness or behavior that, as evidenced by documentation obtained or the
observations made by the department, would endanger the well-being of the
individuals or impair the ability of the provider agency to comply with department
rules and the provider agency failed to take appropriate action to address and respond;
(5) A provider agency, or any of its providers,
staff, contractors, or any representative thereof, knowingly provides
materially false or misleading information to the department;
(6) A provider agency, or any of its providers, staff,
contractors, or any representative thereof, fails to permit or interferes with
any inspection or investigation by the department;
(7) A provider agency, or any of its providers,
staff, contractors, or representatives thereof, fails to provide required
documents to the department or entities acting on its behalf;
(8) Federal or state laws, regulations, or
guidelines are modified in such a way that either providing the services under
the medicaid provider participation agreement is prohibited or the department
is prohibited from paying for such services from the planned funding source; or
(9) The provider agency, provider, or contractor no
longer holds a required license, certification, or other credential to qualify
as a provider of services.
(f)
Enrollment or re-enrollment shall be denied upon the written notice by
the department to the provider agency stating the specific rule(s) with which
the provider agency does not comply.
(g) A provider agency may request an appeal, in
accordance with He-C 200, regarding a proposed denial of enrollment or re-enrollment
within 30 business days of the decision.
(h) The provider agency’s enrollment status shall be
suspended until the appeal determination is adjudicated.
(i) The denial shall not become final until the
period for requesting an appeal has expired, or, if the provider agency
requests an appeal, until such time as the administrative appeals unit issues a
decision upholding the department’s decision.
(j)
If the department’s decision is not upheld, the denial would be
ineffective, and the provider shall continue to provide services.
(k)
Appeals shall be submitted in writing, to the bureau administrator in
care of the department’s office of client and legal services.
(l) Each enrolled provider shall:
(1) Submit
claims for payment in accordance with He-M 504.05; and
(2) Be subject to
monitoring by the department or entities acting on its behalf, in accordance
with the requirements of He-M 504.09, He-M 500, and He-M 1201.
(m) An enrolled provider or applicant shall update
MMIS and notify the department, in writing to the bureau chief, or designee, of
any material change in any status or condition of any element on their
application within 30 days of the change occurring for changes such as, but not
limited to:
(1) Business affiliation;
(2) Ownership and control information;
(3) Federal tax identification number;
(4) Criminal convictions;
(5) Addition to the bureau of elderly and adult
services (BEAS) or DCYF state registries; and
(6) The types of services that are offered.
(n)
An enrolled provider shall notify any applicable service coordination
agency if any change results in a change to the provider agency’s ability to
deliver services to an individual as outlined in that individual’s service
agreement within 2 business days.
(o)
An enrolled provider or provider applicant shall notify any applicable
area agency or service coordination agency if any change impacts their status
as a provider agency within 2 business days.
(p)
An enrolled provider shall immediately notify, in writing, the
department, any applicable area agencies, any applicable service coordination
agencies, and any individuals receiving services from the provider agency, in
accordance with He-M 504.13 of their decision to terminate their status as an
enrolled provider and update the MMIS at least 90 days prior to the termination
date.
(q)
Enrolled providers terminating in accordance with (n) above shall ensure
each individual’s full service file and any other pertinent documentation is
transferred to their respective service coordination agency within 2 business
days of the notification.
(r) Documentation of services provided between the
date of notice and the last date of service provision shall be transferred to
the respective service coordination entity no more than 2 business days after
the end of service provision.
(s)
Claims submitted by, or payments made to, enrolled provider agencies who
have not timely furnished the notification of changes or have not submitted any
of the items that are required due to a change, in accordance with (n)-(q)
above, shall be denied payment or be subject to recovery.
He-M 504.05 Payment for Services.
(a) Provider agencies shall submit all initial claims to the MMIS, so
that the claims are received within 90 days after the date of service on the
claim.
(b) If a
provider agency has submitted a claim in compliance with (a) above and it is
denied, the provider agency shall resubmit the claim within 15 months from the
earliest date of service if the provider agency still wishes to receive reimbursement.
(c) Submission of claims in accordance with (a)
and (b) above shall constitute the provider agency’s assurance that:
(1) The service was delivered in compliance with
all applicable federal and state rules and requirements in effect on the date
the service(s) was provided, including but not limited to, the home and community
based waiver services, chapter He-M 500, He-W 520, He-W 521, and CFR 455.410;
(2) The provider agency has created and maintained
all records necessary in accordance with He-M 503, He-M 517, He-M 522, and He-M
524;
(3) The provider agency is prepared to share
records with the department or the department’s designee, including area
agencies, within 30 days as requested; and
(4) The information included within the claim is
accurate and complete.
(d) Provider
agencies shall not bill the individual for medicaid covered services, even if
medicaid denies the claim, when the individual
is eligible for medicaid and approved for the service provided.
(e) Claims submitted by, or payments made to,
provider agencies who have not timely billed pursuant to this part shall be subject
to denied payment or recovery.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.06 Pass-Through Billing.
(a)
Pass-through billing shall be permissible for the following home and
community based waiver services:
(1) Assistive technology;
(2) Environmental
and vehicle modification services;
(3) Individual goods and services;
(4) Non-medical transportation;
(5) Personal emergency response system;
(6) Community integration services;
(7) Respite;
(8) Wellness coaching; and
(9) Specialty services for assessments,
consultations, and evaluations.
(b) An OHCDS that provides pass-through billing
shall:
(1) Establish itself as the enrolled provider for
the home and community based waiver
service(s) in (a)
above for which pass-through billing will be done;
(2) Hold a contract or other agreement with a
provider or provider agency for service provision, except that provision of goods,
other than environmental or vehicle modifications, shall not require a contract
or agreement;
(3) Ensure that the providers and provider
agencies with whom it contracts, or has agreements with, meet:
a. The service and provider qualification standards
under the applicable home and community based services waiver, He-M 504 and
He-M 506 to provide the services pursuant to (1) above;
b. Medicaid requirements and are free from
sanctions or exclusions or are otherwise not excluded from receiving medicaid
reimbursement;
c. Medicaid office of inspector general screening
requirements prior to service delivery and monthly thereafter;
d. All federal and
state rules and requirements; and
e. All applicable
regulatory and industry standards and maintains good standing as a provider
agency;
(4) Submit claims to MMIS for rendered services and
goods and ensure that records are maintained to verify that such services and
goods were provided in the amount, scope, and frequency that was claimed;
(5) Reimburse subcontractors;
(6) Submit to the bureau
within 30 days of the close of the state fiscal year, in addition to all other
required reports and statements, an aggregate annual summary delineating OHCDS
activities, including subcontractor names, amounts paid per subcontractor,
nature of services, and number of individuals served by each subcontractor;
(7) Ensure that it maintains detailed records,
available for the department, its designee,
or respective individual, at request for
review at any time, to verify the purchase of services and goods outlined in (a)
above; and
(8) Ensure that
policies and practices do not:
a. Restrict any home and community-based waiver
services provider agency or provider to participate only through an OHCDS and
that such arrangements are voluntary; and
b. Restrict individuals into securing services
exclusively through an OHCDS.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.07 Third
Party Liability. All third party obligations shall be exhausted
before medicaid may be billed, in accordance with 42 CFR 433.139.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.08 Monitoring and Determination of Cost
Effectiveness.
(a) Each provider agency shall submit to the
department annually, cost reporting information, which includes, but is not
limited to, the following:
(1) A signed statement certifying that the information
provided is true, accurate, and complete and acknowledging that penalties for
any false statement or misrepresentation of material fact include fine or
imprisonment;
(2) Financial statements
and schedules for the reporting period;
(3) Expenses,
including all personnel related expenses; and
(4) Information
reflective of the most recent desk audit or field audit adjustments made to the
previous cost report, if applicable,
with the exception of items still under appeal that have not been resolved.
(b)
Complete cost information shall be submitted:
(1) No later than
120 days after the end of the state fiscal year, unless an extension has been
granted by the department, pursuant to (g)-(h) below; or
(2) By the former
owner of the organization within 90 days of the sale of the entity when a
change in ownership occurs.
(c)
The department shall consider annual cost information reported to be
incomplete if it is not provided in accordance with (a) above.
(d)
The department shall audit the cost information reported not less than
every 3 years.
(e)
Any provider agency that submits incomplete cost reporting information
shall be subject to penalties described in (i) below, unless an extension has
been granted pursuant to (g)-(h) below.
(f)
The department shall notify the provider agency of incomplete cost
reporting information within 30 days of receipt of information and the
timeframe for submitting complete cost reporting information as described in
(b)(1)-(2) shall not change due to an incomplete report submitted by a provider
agency.
(g) Requests for extensions for submitting cost
reporting beyond the prescribed deadline shall:
(1) Be in writing;
(2) Be submitted to the department at least 10
business days prior to the due date, unless one of the circumstances identified
in (h)(1)-(4) below occurs during the 10 business day prior to the due date, in
which case the request shall be made by telephone within 10 business days of
the occurrence;
(3) Clearly explain the necessity for the extension;
and
(4) Specify the date on which the report shall be
submitted.
(h) Approval of extensions shall be made only if
it is determined that the delay is caused by circumstances beyond the provider
agency’s control, such as, but not limited to:
(1) Natural or manmade disasters;
(2) Strikes by
employees;
(3) The death of
an owner or senior management; or
(4) Any other
instances where the agency can demonstrate a critical impact to operations.
(i) Failure to submit the required cost information
shall result in delayed or reduced payments effective on the first day of the
month following the due date for filing of cost information, and for each
successive month of delinquency in filing the completed cost information.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.09 Utilization
Review and Control. The department’s program integrity unit
shall monitor utilization of home and community-based
waiver services to identify, prevent, and correct potential occurrences of
fraud, waste, and abuse in accordance with in accordance with He-W 520, 42 CFR
455, and 42 CFR 456.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.10 Fraud Detection
and Investigation.
(a) In accordance with 42
CFR 455.14, the department’s program integrity unit shall address complaints of
medicaid fraud, waste, or abuse from any source or the identification of
any questionable practices after analysis of paid claim history by conducting a
preliminary investigation.
(b) Cases where potential
fraud has been detected as a result of a preliminary investigation pursuant to
(a) above, shall be referred for a full investigation to the appropriate
agency, in accordance with 42 CFR 455.15.
(c) A full investigation and resolution shall be
conducted in accordance with 42 CFR 455.16.
(d) The department shall
recoup state and federal medicaid payments as permitted by 42 CFR 455, 42 CFR
447, and 42 CFR 456 for a provider agency’s failure to maintain supporting
records in accordance He-W 520 and He-M 504.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.11 Provider and Provider Agency Staff
Requirements.
(a)
All providers shall meet the applicable provider training requirements
in He-M 506.
(b)
All provider agency staff, providers, and contractors who have direct
contact with individuals and families shall participate in a person-centered
thinking program and demonstrate competencies by March of 2025 and every 5
years thereafter.
(c)
All provider agency staff, providers, and contractors who have direct
contact with individuals and families shall participate in at least one
person-centered thinking course per year.
(d)
Person-centered trainings and programs for (b)-(c) above shall consist
of nationally recognized models and best practices as identified by the National Center on
Advancing Person-Centered Practices and Systems (NCAPPS) or the National
Alliance for Direct Support Professionals NADSP.
(e)
Providers of the following services shall not be subject to the
requirements in (b)-(c) above:
(1) Assistive technology;
(2) Environmental and vehicle modification services;
(3) Individual goods and services;
(4) Non-medical transportation;
(5) Personal emergency response services;
(6) Community integration services;
(7) Respite;
(8) Wellness coaching; and
(9) Specialty services for assessments,
consultations, and evaluations.
(f)
Providers who offer services listed in (e) above and any additional services
shall be subject to the requirements of (b)-(c) above.
(g)
Providers who are also family members shall be subject to (b)-(c) at the
discretion of the individual and guardian.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.12 Suspension and
Revocation of Provider Enrollment.
(a)
If the department finds at any time that an enrolled provider repeatedly
fails to meet their participation, information sharing and billing obligations, or that their continued operations endanger
the health, safety, or welfare of individuals, or the public, the department
shall order the suspension or revocation of the enrolled provider.
(b)
Suspension shall include receiving notice from the department of its
intent to suspend payment of any claims submitted or the provider enrollment ID
for the specific service location associated with the violation or, if the
violation is specific to all sites, the provider enrollment ID’s for that
provider agency.
(c)
Revocation shall include receiving notice from the department of its
intent to revoke the provider enrollment ID for the specific service location
associated with the violation or, if the violation is specific to all sites,
the provider enrollment ID’s for that provider agency.
(d)
When a claim or provider enrollment suspension is issued, pursuant to (b)
above, a plan of correction shall be issued by the department which shall
outline the conditions necessary for reinstatement including if the provider agency
shall be permitted to continue to provide services during a claim suspension
period.
(e)
If the provider agency is permitted to continue providing services
during the suspension period, the processing and payment of claims shall be
suspended until the provider has met the requirements of the corrective action
plan.
(f)
If a provider agency is not permitted to continue providing services
during the suspension period, the department shall deny claims for payment or
other reimbursement requests for dates of service during the suspension period.
(g)
Provider agencies shall remain under suspension until specified conditions
for reinstatement as outlined in a corrective action plan issued pursuant to (d)
above, are met and approved by the department.
(h)
If the provider agency does not meet the conditions for reinstatement, as
outlined in a corrective action plan, a recommendation shall be made for
enrollment termination to the department’s program integrity unit.
(i)
A provider agency may request an appeal, in accordance with He-C 200, regarding
a proposed suspension or revocation of enrollment within 30 business days of
the decision.
(j) The provider’s enrollment status shall be
suspended until the appeal determination is adjudicated.
(k) The revocation shall not become final until
the period for requesting an appeal has expired, or, if the provider agency
requests an appeal, until such time as the administrative appeals unit issues a
decision upholding the department’s decision.
(l)
If the department’s decision is not upheld, the denial would be
ineffective, and the provider shall continue to provide services.
(m)
Appeals shall be submitted in writing, to the bureau administrator in
care of the department’s office of client and legal services.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.13 Discontinuation of Services by Provider or
Provider Agency.
(a)
A provider agency that is not delivering services in conjunction with a residency
agreement, in accordance with He-M 310.10(c), shall immediately provide the
individual, guardian, and service coordinator, with a written 90-day notice
that clearly describes the basis for the provider agency’s decision to discontinue
service provision and all reasonable efforts made by the provider agency to
work with the participant and guardian to maintain such service provision.
(b) When written notice is issued in accordance
with (a), services shall not end before the 90-day notice period except by
mutual agreement of the individual, guardian, and provider agency.
(c) A provider agency that is delivering services in
conjunction with a residency agreement, in accordance with He-M 310.10(c),
shall follow the procedures for notification outlined in He-M 310.
(d) If a notice to discontinue services is issued in accordance with (a)
above, the following actions shall occur:
(1) The provider agency shall transfer a copy of the
individual’s full service file to their service coordination agency within 2
business days;
(2) The
service coordinator shall conduct service planning for any necessary
transitions, in accordance with He-M 503, He-M 522, or He-M 524 within 5
business days; and
(3) The
provider and provider agency shall participate in service planning
and provision based on developments resulting from (2) above during the notice
period outlined in (a) above or the transition period to a new provider agency.
(e)
If a notice is issued in accordance with (b) above, the following shall occur:
(1) The provider agency shall transfer a copy of
the individual’s full service file to their service coordination agency within
2 business days;
(2) The service coordinator shall conduct service
planning for any necessary transitions in accordance with He-M 310.10; and
(3) The provider agency shall provide the service
coordinator with alternative residential options, if applicable, or demonstrate
a good faith effort to provide this information.
(f) An individual or guardian may request an appeal
of a notice provided in accordance with (a) above, unless the reason for
discontinuation of services is due to the provider agency’s cessation of
services.
(g) Appeals shall be filed, in writing, to the
bureau administrator in care of the department’s office of client and legal services
within 30 days following the date of notification of service discontinuation,
in accordance with (a) above and He-C 200.
(h) If an
appeal is requested, the following actions shall occur:
(1)
Services and payments shall be continued as a consequence of an appeal for a
hearing until a decision has been made; and
(2) If
the provider agency’s decision is upheld, services shall cease 60 days from the
date of the denial letter or 30 days from the hearing decision, whichever is
later.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23
He-M 504.14 Waivers.
(a) A provider applicant, area agency, provider
agency, individual, guardian, or provider may request a waiver of specific
procedures outlined in He-M 504 by completing and submitting the form titled
“NH Bureau of Developmental Services Waiver Request” (October 2023 edition) in
accordance with (b) and (c) below.
(b)
A completed waiver request form shall be signed by the provider agency’s
executive director or designee recommending approval of the waiver.
(c)
A waiver request shall be submitted to the department via:
(1) Email at bds@dhhs.nh.gov;
or
(2) By mail to:
Bureau of
Developmental Services
Hugh J. Gallen
State Office Park
105 Pleasant
Street, Main Building
Concord, NH 03301
(d)
No provision of procedure prescribed by statue shall be waived.
(e)
The request for a waiver shall be granted by the commissioner or
designee within 30 days if the alternative proposed by the requesting entity
meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not affect the quality of services to
individuals.
(f)
Upon receipt of approval of a waiver request, the requesting entity’s
subsequent compliance with the alternative provisions or procedures approved in
the waiver shall be considered compliance with the rule for which waiver was
sought.
(g)
Waivers shall be granted in writing for the minimum period necessary to
accommodate the waiver request, with a specific duration not to exceed 5 years
except as in (h)-(i) below.
(h)
Any waiver shall end with the closure, termination, revocation, or
suspension of the related program or service.
(i)
A requesting entity may request a renewal of a waiver from the bureau. Such request shall be made at least 30 days
prior to the expiration of a current waiver.
Source. #13679,
EMERGENCY RULE, eff 6-28-23; ss by #13807, eff 11-17-23; (see also Revision
Note at part heading for He-M 504)
PART
He-M 505 ESTABLISHMENT AND OPERATION OF
AREA AGENCIES
Statutory Authority:
RSA 171-A:3; 171-A:18, I, IV
He-M
505.01 Purpose. The purpose of these rules is to define the
procedures and criteria for the establishment, designation, and redesignation
of area agencies, and to define their role and responsibilities.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM, eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23
(a)
“Acquired brain disorder” means a disruption in brain functioning that:
(1) Is not congenital or caused by birth trauma;
(2) Presents a severe and life-long disabling
condition which significantly impairs a person’s ability to function in
society;
(3) Occurs prior to age 60;
(4) Is attributable to one or more of the
following reasons:
a. External trauma to the brain as a result of:
1. A motor vehicle incident;
2. A fall;
3. An assault; or
4. Another related traumatic incident or
occurrence;
b. Anoxic or hypoxic injury to the brain such as
from:
1. Cardiopulmonary arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases such as encephalitis and
meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; or
h. Other neurological disorders such as
Huntington’s disease or multiple sclerosis which predominantly affect the central
nervous system; and
(5) Is manifested by one or more of the
following:
a. Significant decline in cognitive functioning
and ability; or
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits;
(b)
“Applicant group” means a group of area citizens that has submitted the
required materials to the bureau for consideration for designation as an area
agency;
(c)
“Area” means “area” as defined in RSA 171-A:2, I-a, namely “a geographic
region established by rules adopted by the commissioner for the purpose of
providing services to developmentally disabled persons.”;
(d)
“Area agency” means “area agency” as defined in RSA 171-A:2, I-b;
(e)
“Area board” means “area board” as defined in RSA 171-A:2, I-c, namely
“the governing body or board of directors of an area agency.”;
(f)
“Area plan” means a document prepared by the area agency that outlines
that agency’s goals, objectives, and activities pursuant to He-M 505.04(p) and
RSA 171-A:18;
(g)
“Bureau” means the bureau of developmental services of the department of
health and human services;
(h)
"Bureau administrator" means the chief administrator of the
bureau of developmental services;
(i)
“Commissioner” means the commissioner of the department of health and
human services, or their designee;
(j)
“Conditional redesignation” means a written ruling by the commissioner
pursuant to He-M 505.10 that an area agency has partially complied with the
redesignation criteria listed in He-M 505.09 and that continued designation is
contingent upon fulfilling the requirements established by He-M 505;
(k) “Critical incident” means an alleged,
suspected, or actual occurrence of:
(1) Abuse, including physical, sexual, verbal, and
psychological abuse;
(2) Neglect;
(3) Exploitation;
(4) Serious injury;
(5) Death other than by natural causes; and
(6) Other events that threaten the health or
safety of an individual such as hospitalizations, administration of the wrong medication,
failure to administer medication, or use of restraints or behavioral
interventions that are not included in an approved behavior change program;
(l)
“Designation” means a written ruling by the commissioner that an
applicant group has been determined to be in compliance with the eligibility
requirements set forth in He-M 505.06 and has been approved as the area agency
for the area;
(m)
“Developmental disability” means “developmental disability” as defined
in RSA 171-A:2, V, namely, “a disability:
(a) Which is attributable to an intellectual
disability, cerebral palsy, epilepsy, autism, or a specific learning disability,
or any other condition of an individual found to be closely related to
intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability; and
(b) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual's ability to function
normally in society.”;
(n) “Financial management services” means fiscal
intermediary services available to individuals who elect to direct and manage
their services, pursuant to He-M 524 and He-M 525;
(o)
“Generic services” means services available to the general population
that are not specifically designed for individuals;
(p) “Governance review” means an announced review
to monitor annual compliance of area agency operations including, but not
limited to, services, programs, functions, and finances, whether operated
directly by the area agency or through contracts with persons or organizations;
(q)
“Guardian” means a person appointed pursuant to RSA 463 or RSA 464-A or
the parent of an individual under the age of 18 whose parental rights have not
been terminated or limited by law;
(r)
“Individual” means a person who has a developmental disability or
acquired brain disorder;
(s) “Integrated activity” means
personal interaction between persons with and without developmental
disabilities or acquired brain disorders that occurs within community settings;
(t)
“Integrated setting” means a setting where the majority of persons are
without developmental disabilities and the primary activity is neither
bureau-funded nor designed primarily for individuals;
(u)
“Interim designation” means a written ruling by the commissioner
pursuant to He-M 505.06 (e)(8) that an applicant group or other organization
has been approved as the interim area agency until a final designation is made
by the commissioner;
(v)
“Mission” means the stated goals of the service system as established by
the bureau or area agencies;
(w) “Problematic sexual behavior” means non-consensual
touching or attempting to touch another person’s body in a sexualized manner,
unsolicited sexualized statements, public exposure, and illegal sexual conduct
whether in person or online;
(x) “Provider” means a person receiving any form
of remuneration for the provision of services to an individual;
(y) “Provider agency” means an agency or an
independent provider that is established to provide services to individuals;
(z) “Region” means, when followed by a Roman
numeral, the area agency in the area corresponding to the identified numeral;
(aa) “Registry” means the list maintained in the
department’s electronic database which itemizes identified service needs for
individuals in the following 5 years;
(ab) “Sentinel event” means an unexpected
occurrence involving death or serious physical or psychological injury, or risk
thereof. Serious injury specifically includes loss of limb or function. Categories
of reportable sentinel events are individual-centered events, in which the
individual is either a victim or perpetrator, including, but are not limited
to:
(1) Any sudden, unanticipated, or accidental
death, not including homicide or suicide, and not related to the natural course
of an individual’s illness or underlying condition;
(2) Permanent loss of function, not related to the
natural course of an individual’s illness or underlying condition, resulting
from such causes including but not limited to:
a. A medication error;
b. An unauthorized departure or abduction from a
facility providing care; or
c. A delay or failure to provide requested or
medically necessary services due to waitlists, availability, insurance
coverage, or resource limits;
(3) Homicide;
(4) Suicide;
(5) Suicide attempt, such as self-injurious behavior
with a non-fatal outcome, with explicit or implicit evidence that the person
intended to die and medical intervention was needed;
(6) Rape or any other sexual assault;
(7) Serious physical injury;
(8) Serious psychological injury that jeopardizes
the person’s health that is associated with the planning and delivery of care;
(9) Injuries due to physical or mechanical
restraints; and
(10) High profile or high risk event, such as:
a. Media coverage; and
b. Police involvement leading to an arrest;
(ac) “Service coordination agency” means a provider
agency providing service coordination services to individuals that meets the criteria in He-M 504; and
(ad) “Service
coordinator” means a provider who meets the criteria in He-M 503 or He-M 522
and is chosen by an individual and their guardian or representative to
organize, facilitate, and document service planning and to negotiate and
monitor the provision of the individual’s services.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23
He-M 505.03 Role and
Responsibilities of the Area Agency.
(a) The primary responsibility of an area agency, designated in
accordance with He-M 505, shall be to plan, establish, or maintain
comprehensive service access and delivery for all individuals who are residing
in the area, in accordance with RSA 171-A and the rules promulgated thereunder,
by:
(1) Maintaining a current
contract with the department to serve as an area agency;
(2) Managing and providing family
support services in accordance with He-M 519;
(3) Managing and providing family
centered early supports and services in accordance with He-M 510;
(4) Providing or supporting the
arrangement of financial management services for individuals who choose to direct
and manage their waiver services;
(5) Managing and completing
intake and eligibility activities for individuals in order to determine access
to the developmental services system in accordance with He-M 503 and He-M 522
and to facilitate and assist individuals in applying for and maintaining Medicaid
benefits;
(6) Developing and managing
initial service planning and access to supports for individuals found to be
eligible for services pursuant He-M 503, He-M 522, or He-M 524;
(7) Providing oversight and
management of the provider network by:
a. Coordinating and monitoring
the provider network to support the needs of the catchment region as outlined
in the agency’s area plan, developed pursuant to He-M 505.04 (p);
b. Communicating relevant
service delivery system updates to provider agencies and provide training as
needed;
c. Monitoring current service
capacity using data from the bureau to identify risk and solutions;
d. Reporting to the bureau
quarterly, the results from monitoring in c. above and follow up on actions
taken pursuant to f. below, to support provider network management;
e. Promoting the establishment
of new provider agencies to increase service capacity as determined by the
bureau based on the data provided in d. above; and
f. Providing follow-up to the
bureau on actions taken in accordance with e. above;
(8) Providing information,
education, and referrals to the service delivery system, as defined in RSA
171-A:2, XVI, by:
a. Providing objective
information and assistance that empowers people to make informed decisions
about their services and supports; and
b. Networking and partnering
with community organizations with the goal of supporting inclusive community
life, leveraging natural resources, services, and supports, and in improving
the community’s understanding of the service delivery system;
(9) Managing registry
documentation by:
a. Assisting individuals in the
determination of and documentation of need for services to be provided,
pursuant to He-M 503, within 5 years from the date of initial eligibility; and
b. Reviewing and updating the
registry as early as practicable anytime a need for services in the next 5
years is identified;
(10) Submitting level of care
submissions to the bureau in accordance with He-M 517 and He-M 524 for initial
level of care determinations as well as level of care determinations for transfers
between home and community based services waivers;
(11) Initiating waiver services
in accordance with He-M 503, He-M 522, and He-M 524 including:
a. Facilitating the scheduling
of an individual’s initial supports intensity scale assessment for individuals
who do not have a service coordinator;
b. Providing resources to an
individual regarding service coordination agencies so the individual can select
a service coordination provider; and
c. Following bureau approval of
level of care in accordance with He-M 503.05, submission of the individual’s
selection in accordance with b. above to NH Easy for provider review and
acceptance;
(12) Maintaining and updating records in the electronic database NH
Easy at https://nheasy.nh.gov/#/
;
(13) Completing service utilization and quality oversight by:
a. Managing service agreement
development through monthly monitoring of annual service agreement renewals;
b. Reviewing service agreements
quarterly and communicating any identified needs to applicable service provider
agencies;
c. Managing and overseeing
submission of out-of-state service provision requests to the bureau;
d. Monitoring provision of
services as prescribed in the service agreement by:
1. Completing annual service
and post-payment audits using a tool provided by the bureau within 60 days of
request by the bureau; and
2. Providing results of the
audits completed in accordance with (1) above to include raw data, aggregated
data, and analysis of findings;
e. Assessing annual
satisfaction with quality of services, and reviewing and continuously improving
quality of services by:
1. Soliciting feedback from individuals and families within the
agency’s geographic region; and
2. Providing results of the
feedback received in accordance with (1) above to include raw data, aggregated
data, and analysis of findings;
f. Completing inquiry and
review at the request of the bureau related to service concerns, complaints, or
grievances;
g. Ensuring training and
education dissemination related to identified trends of sentinel events,
restraint and seclusion, and mortality. Area agencies shall ensure that at
least one training per state fiscal year quarter is offered and provided to
those who register;
h. Collaborating with the community
mental health center that serves the region to support coordinated service planning and delivery for
individuals accessing or wishing to access services from both service systems;
and
i. Collaborating with the regional
public health network that serves the region to support emergency planning processes in order to
develop and execute response and recovery plans;
(14) Increasing access to employment by:
a. Acting on employment trends,
as identified by the bureau; and
b. Participating in the
employment leadership committee pursuant to He-M 518;
(15) Providing critical
incident management by:
a. Collecting restraint and
seclusion data and providing such data to the bureau quarterly with analysis of
findings on a tool approved by the bureau;
b. Finalizing mortality
notifications and reviews received from provider agencies and submitting these
reviews to the bureau;
c. Finalizing sentinel event
reports and submitting these reports to the bureau;
d. Reviewing reports of
incidents to determine if a sentinel event report is needed;
e. Monitoring follow-up related to findings from formal complaint
investigations conducted pursuant to He-M 202;
f. Providing coordination,
logistical support, and subject matter expertise to service coordinators regarding
crisis mitigation situations;
g. Providing crisis data to the
bureau quarterly with analysis of any observed findings on a tool approved by
the bureau;
h. Ensuring area agency availability 24/7 in order to provide critical
incident coordination, logistical support, and subject matter expertise;
i. Completing expedited intake and eligibility supports to individuals
who are experiencing a critical incident but have not sought eligibility for
services through the developmental services system; and
j. Facilitating strategy
development and coordination meetings in collaboration with the bureau;
(16) Monitoring, maintaining, safeguarding, and promoting human rights
by:
a. Maintaining and facilitating
a human rights committee, whose duties pursuant to RSA 171-A:17 for all
individuals working with the committee, shall be;
1. Monitoring and approving all
positive behavior change programs created pursuant to He-M 310.11;
2. Ensuring emergency physical restraint
shall only be approved for safely responding to situations in which the
individual presents with an imminent credible risk of significant harm to self
or others by staff who are trained and certified in recognized intervention
modalities;
3. Evaluating the treatment and
habilitation provided to individuals;
4. Regularly monitoring the
implementation of individual service agreements;
5. Monitoring the use of
restrictive or intrusive interventions designed to address challenging behavior
pursuant to He-M 310.11; and
6. Promoting advocacy programs
on behalf of individuals;
b. Offering and providing to
those who register, 2 trainings per year on advocacy and individual rights;
c. Maintaining and distributing
a list of current advocacy groups within the catchment area; and
d. Completing informal
investigations pursuant to He-M 202.05;
(17) Managing catchment region risk by:
a. Coordinating and
facilitating a local risk management committee whose duties shall be:
1. Reviewing and analyzing referrals
from service coordinators related to violent aggression, problematic sexual
behavior, or fire-setting behaviors;
2. Making assessment or evaluation referral recommendations to service
coordinators for individuals exhibiting behaviors including but not limited to
violent aggression, problematic sexual behaviors, or fire-setting behaviors;
3. Reviewing assessment and
evaluation results completed for individuals for whom a referral was submitted in
accordance with 2. above to determine whether a need is identified for a plan
to manage risk;
4. Providing consultation to
service coordinators in identifying providers to create plans to manage risk
who have expertise in the areas identified in 1. above;
5. Reviewing plans to manage
risk created when a recommendation for such a plan was made pursuant to 4 above
to ensure it appropriately applies assessment or evaluation recommendations
received pursuant to 3. above;
6. Participating in committees and other groups related to risk
management including, but not limited to, statewide risk management committees,
and communities of practice to determine application of assessment or
evaluation recommendations received pursuant to 2. above;
7. Reviewing documentation from
service coordinators and provider agencies on an ongoing basis to determine the
impact of such data relative to management of risk for an individual and
related plans;
8. Ensuring that plans to
manage risk created when a recommendation for such a plan was made pursuant to 4
above are reviewed regularly with individuals and their treatment team to
consider ongoing appropriateness and, in the event that potential changes are
indicated, seeking additional consultation with providers qualified to conduct
and author assessments, whether they created the initial plans or are new, to
discuss opportunities for modification of restrictions by sharing data
regarding the individual’s progress in treatment. Such considerations shall be
made through reassessment or through a consultative review of other
documentation and updated data related to the individual’s progress;
9. Offering recommendations to
the area agency for training for the service system;
10. Offering recommendations,
as applicable, to service coordinators for individual-specific training needs;
11. Conducting training related
to risk management activities, as requested by the area agency;
12. Ensuring that provider
agencies and providers are trained in risk management plans;
13. Ensuring that relevant area
agency personnel, provider agencies, and providers receive recommendations for clinically
specialized trainings, based on assessed needs of the individuals supported,
that enable these personnel to successfully complete risk management activities;
and
14. Ensuring monthly
representation in the statewide risk management committees; and
b. Collaborate with all area
agencies to co-facilitate and convene a statewide risk management committee;
(18) Managing Health Risk Screening Tool (HRST) IntellectAbility
accounts and data at https://nhbds.hrstapp.com/ by:
a. Providing administrative
support for HRST account management; and
b. Completing a clinical review
for individuals with a score greater than or equal to 3;
(19) Managing New Hampshire
Easy (NH Easy) accounts and data by:
a. Ensuring that appropriate
staff receive and maintain access to NH Easy in order to carry out duties;
b. Ensuring that the area agency’s
NH Easy account remains in good standing; and
c. Notifying NH Easy support of
any noted system issues;
(20) Completing the request for
the funding of a public guardian if the individual does not have a service
coordinator;
(21) Participating in medication
administration planning by:
a. Attending the state medication
committee meeting as defined in He-M 1201.11;
b. Reviewing the 6-month medication
error reports described in He-M 1201.11(c)-(e); and
c. Offering and providing to
those who register, training to provider agencies and providers about
medication administration trends as determined by the state medication
committee and confirmed by the bureau;
(22) Completing information
gathering via survey by:
a. Disseminating and
coordinating the annual national core indicator satisfaction surveys;
b. Reviewing survey results to
identify areas of quality improvement; and
c. In partnership with the
bureau, distributing and reviewing survey results to ensure continuous quality
improvement of the service delivery system;
(23) Maintaining records
pursuant to He-M 503, He-M 510, He-M 517, He-M 519, and He-M 522, as applicable;
and
(24) Managing transitions
between regions.
(b) Failure of a
provider agency to comply with the requirements in He-M 504 with respect to providing
an area agency with necessary information or participating in activities in
order for an area agency to carry out its responsibilities in (a) above shall
not be considered noncompliance by an area agency.
(c) In instances of
a provider agency failure as reflected in (b) above, the area agency shall
notify the bureau within 15 days.
(d) For items
(a)(4)–(24), Medicaid administrative reimbursement may be claimed by the
designated and contracted area agency for activities completed each month on
behalf of individuals in the area who are eligible for or seeking eligibility
for Medicaid.
(e) Pursuant to RSA
171-A:18, I, the area agency shall be the primary recipient of these funds
provided by the bureau for use in establishing, operating, and administering
supports and services and coordinating these with existing generic services on
behalf of individuals in the area. The area agency may receive funds
from sources other than the bureau to assist it in carrying out its
responsibilities.
(f) In order to collect Medicaid
administrative reimbursement, pursuant to (d) above, the area agency shall:
(1) Ensure that records are maintained
to support that the services in (a)(4)-(24) above were provided in the manner
that was claimed;
(2) Ensure that records pursuant
to (1) above are made available to the bureau or any state or federal auditing
entity; and
(3) Provide information
regarding services, supports, and costs, as requested by the department not
less than every 5 years.
(g) When possible, the area agency shall utilize
community based, integrated services, rather than establish separate services
for people with developmental disabilities or acquired brain disorders.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; amd by #8443, eff 1-1-06;
amd by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23
He-M 505.04 Governance and
Composition of the Area Agency Board.
(a) Each area agency board shall establish policies
and procedures for the governance and administration of the area agency and
those policies and procedures shall:
(1) Be developed to ensure
efficient and effective operation of the local service delivery system;
(2) Be developed to adhere to
the requirements of state and federal funding sources, the area plans, and the rules
and contracts established by the department; and
(3) Be developed to ensure that
the area agency avoids any conflict of interest and any appearance of conflict
of interest in its business relationships.
(b) The department shall assist area agencies in
the establishment and provision of services through contract establishment,
contract monitoring, consultation, technical assistance, guidance regarding service
reviews, staff and board training, coordination with other service systems, and
other means.
(c) The area agency shall be incorporated and
have an established plan for governance in accordance with He-M 505.04 (d)-(p)
below.
(d) The area agency board shall have
responsibility for the entire management and control of the property and
affairs of the corporation and have the powers usually vested in the board of
directors of a not-for-profit corporation, except as regulated herein. This shall be stated in a set of bylaws
maintained and updated by the area board.
(e) The area board shall include in its articles
of incorporation and its bylaws a statement that, in the event of dissolution
of the area agency or in the event that the agency is no longer designated as
an area agency, disposal of all debts and obligations shall be provided for.
(f) Each area agency board shall include in its
bylaws:
(1) A provision requiring rotation of area board membership so that
1/4 of the members’ terms expire each year.
Said rotation shall not result in all terms of individuals, guardians,
or family members expiring in the same year;
(2) A provision that the maximum consecutive period during which a
board member may serve as an officer of the board shall not exceed 6 years; and
(3) A procedure by which
inactive members are removed from the area board.
(g) The size and composition of the area agency board
shall be as follows:
(1) In all cases, the board of
directors shall be composed of an uneven number of persons;
(2) The number of persons
serving as members shall be no fewer than 9 and no more than 25;
(3) Individuals, guardians, and
family members shall comprise at least 1/3 of the membership of the area agency
board;
(4) Members shall be representative
of the agency’s individuals supported, their family members, and the entire
area; and
(5) Membership shall be open to
persons who reside in the area except for those excluded as follows:
a. Persons or the spouses of
persons who are under financial contract with the area agency or any
organization that is a subsidiary or affiliate of the area agency shall not be
eligible for membership on the area board;
b. Employees or the spouses of
employees of agencies that are under financial contract with the area agency
shall not be eligible for membership on the area board;
c. Employees or the spouses of
employees of the area agency shall not be eligible for membership on the area
board;
d. Employees of the New
Hampshire department of health and human services or their spouses shall not be
eligible for membership on the area board; and
e. Volunteer board members or
the spouses of volunteer board members of agencies or programs under contract
with the area agency shall be eligible for membership on the area board but
shall comprise no more than 1/3 of the board.
(h) All area agency board
members shall participate in at least one nationally recognized person-centered
thinking training when they begin their first term of board membership and
every 5 years thereafter.
(i) The area board shall fill vacancies by
soliciting interested persons to submit applications to the area board. Such
solicitation shall be by conducting public meetings, placing public
announcements in local media, and by any other means.
(j) Pursuant to RSA 171-A:18, III, the area board
shall appoint an executive director of the area agency. The executive director shall serve at the
pleasure of the area board and as a full-time employee of the agency.
(k) The executive director shall be selected,
employed, and supervised by the area board in accordance with a published job
description and a competitive application procedure pursuant to the area
agency’s personnel policies.
(l) The executive director shall have the following
experience qualifications, at a minimum:
(1) Five years of
administrative experience in human services; and
(2) Four years of experience in
developmental services programs, which may be done all or in part in the above
administrative capacity.
(m) The executive director shall demonstrate
extensive knowledge of all aspects of the fields of developmental disabilities
and acquired brain disorders, including knowledge of:
(1) Administration;
(2) Planning;
(3) Community networking;
(4) Business management; and
(5) Financial and social
resources.
(n) The executive director’s performance shall be
evaluated annually by the area board to ensure that services are provided in
accordance with the agency mission, area plan, contract provisions, and mission
as well as federal and state laws and rules.
(o) Pursuant to RSA 171-A:18, V, the area agency board
shall prepare and submit to the department an area plan for the provision of programs
and services to individuals in the area for a 5-year period that coincides with
the redesignation cycle identified in Table 505-2.
(p) The area plan shall:
(1) Clearly identify the extent
to which the area agency has involved its individuals and families, the area
family support council established pursuant to RSA 126-G:4, the general public
residing in the area, and generic service agencies in the planning and
provision of services for individuals;
(2) Demonstrate that services and
supports for which the agency is responsible, as outlined in He-M 505.03(a), are
intended to establish and maintain a comprehensive service delivery system that
is:
a. Based on the nature and
extent of the service needs of individuals and their care-giving families;
b. Consistent with RSA 171-A
and the agency’s and bureau’s mission statements and priorities;
c. Responsive to the priorities
of the individuals and families in the area agency’s catchment region; and
d. Free from conflict in
accordance with 42 CFR 441.301;
(3) Be submitted to the bureau
administrator for approval pursuant to (q) below; and
(4) Be reviewed by the area
board every 2 years and may be amended by the area board at any time, with such
amendments submitted to the bureau administrator for approval if:
a. The area board proposes to
change, discontinue, or expand services to individuals and their care-giving
families; or
b. Amendment is necessary to
reflect changes in area-wide individual and family needs, legislation, or area
demographics, vendors, or funding.
(q) The bureau administrator, commissioner, or the
commissioner’s designee shall review area plans and amendments to area plans
submitted for approval pursuant to (p)(3) and (4) above and approve those plans
or amendments that are determined to comply with the agency mission and
department rules and other applicable state and federal laws, regulations, and
rules.
(r) The area agency shall utilize all applicable
federal, third party, and other public and private sources of funds to carry
out its mission and responsibilities.
(s) The area agency shall not enter any merger,
sale, affiliation, or other substantial change in its corporate identity
without the prior approval of the bureau administrator, with notice being
provided to the bureau no less than 6 months before the change.
(t) The bureau administrator shall review any proposed merger, sale,
affiliation, or other substantial change in the corporate identity of an area
agency.
(u) The bureau administrator shall assess the potential impact on the
developmental services system stability and approve such proposed changes if they
determine that the developmental services system stability can be maintained
adequately by the resulting organization’s compliance with department rules and
other applicable state and federal laws, regulations, and rules, and that such
changes are in the best interest of individuals residing in the area.
(v) The services, programs, and functions for
which the area agency is responsible to oversee may be provided directly by the
area agency or the area agency may, pursuant to RSA 171-A:18, II, enter into
agreements with persons and organizations for the provision of designated
services. The area agency shall not
delegate its financial management responsibility to any person or organization.
(w) An area agency planning to enter into
agreements pursuant to He-M 505.04 (v) shall:
(1) Obtain written permission from the commissioner pursuant to RSA 171-A:18;
and
(2) Include in said notice a description
of services to be provided, payment schedules, and reporting requirements, and
assurances that the participants in the agreements agree to comply with all
pertinent state and federal requirements.
(x) The area agency shall be responsible and
accountable for all area agency services, programs, and functions whether
administered directly by the area agency or provided under contracts with
persons or organizations.
(y) Monitoring and evaluation of all area agency services, whether
administered directly or by contract, shall be conducted by the area agency
with its findings and any remedial action taken reported to the area agency board.
(z) Area agency services, programs, and functions
shall be operated in compliance with applicable state and federal laws and rules
and contract requirements established by the department and comply with the
goals and priorities of the approved area plan.
(aa) The department shall conduct annual governance
reviews, announced or unannounced reviews of area agencies, and audit area
agencies at least every 5 years, including all or part of any services, programs,
functions, finances, operations, or contract requirements of the area agency,
whether operated directly by the area agency or through contracts with persons
or organizations.
(ab) The results of the review conducted in
accordance with He-M 505.04(aa) above, and any resulting trends in performance,
shall be considered during the redesignation process.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8443, eff 1-1-06;
ss by #8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23
He-M 505.05 Designation of
Area Boundaries. Areas designated
for the purpose of providing services to individuals shall be the developmental
services areas specified in table 505-1, which sets forth the numerical
designation of the areas and lists towns by area:
Table 505-1, INCORPORATED TOWNS AND CITIES BY AREA
Area I
Albany |
Easton |
Lisbon |
Stark |
Bartlett |
Eaton |
Littleton |
Stewartstown |
Benton |
Effingham |
Lyman |
Stratford |
Berlin |
Errol |
Madison |
Sugar Hill |
Bethlehem |
Franconia |
Milan |
Tamworth |
Brookfield |
Freedom |
Monroe |
Tuftonboro |
Carroll |
Gorham |
Moultonborough |
Wakefield |
Chatham |
Hart's Location |
Northumberland |
Warren |
Clarksville |
Haverhill |
Ossipee |
Waterville Valley |
Colebrook |
Jackson |
Piermont |
Whitefield |
Columbia |
Jefferson |
Pittsburg |
Wolfeboro |
Conway |
Lancaster |
Randolph |
Woodstock |
Dalton |
Landaff |
Sandwich |
|
Dummer |
Lincoln |
Shelburne |
|
Area II
Acworth |
Dorchester |
Langdon |
Orford |
Canaan |
Enfield |
Lebanon |
Plainfield |
Charlestown |
Goshen |
Lempster |
Springfield |
Claremont |
Grafton |
Lyme |
Sunapee |
Cornish |
Grantham |
Newport |
Unity |
Croydon |
Hanover |
Orange |
Washington |
Area III
Alexandria |
Bristol |
Groton |
Plymouth |
Alton |
Campton |
Hebron |
Rumney |
Ashland |
Center Harbor |
Holderness |
Sanbornton |
Barnstead |
Ellsworth |
Laconia |
Thornton |
Belmont |
Gilford |
Meredith |
Tilton |
Bridgewater |
Gilmanton |
New Hampton |
Wentworth |
Area IV
Allenstown |
Danbury |
Hopkinton |
Sutton |
Andover |
Deering |
Loudon |
Warner |
Boscawen |
Dunbarton |
Newbury |
Weare |
Bow |
Epsom |
New London |
Webster |
Bradford |
Franklin |
Northfield |
Wilmot |
Canterbury |
Henniker |
Pembroke |
Windsor |
Chichester |
Hill |
Pittsfield |
|
Concord |
Hillsborough |
Salisbury |
|
Area V
Alstead |
Greenville |
Nelson |
Surry |
Antrim |
Hancock |
New Ipswich |
Swanzey |
Bennington |
Harrisville |
Peterborough |
Temple |
Chesterfield |
Hinsdale |
Richmond |
Troy |
Dublin |
Jaffrey |
Rindge |
Walpole |
Fitzwilliam |
Keene |
Roxbury |
Westmoreland |
Francestown |
Lyndeborough |
Sharon |
Winchester |
Gilsum |
Marlborough |
Stoddard |
|
Greenfield |
Marlow |
Sullivan |
|
Area VI
Amherst |
Hudson |
Merrimack |
Nashua |
Brookline |
Litchfield |
Milford |
Wilton |
Hollis |
Mason |
Mont Vernon |
|
Area VII
Auburn |
Candia |
Hooksett |
Manchester |
Bedford |
Goffstown |
Londonderry |
New Boston |
Area VIII
Brentwood |
Greenland |
Newfields |
Portsmouth |
Deerfield |
Hampton |
Newington |
Raymond |
East Kingston |
Hampton Falls |
Newmarket |
Rye |
Epping |
Kensington |
North Hampton |
Seabrook |
Exeter |
Kingston |
Northwood |
South Hampton |
Fremont |
New Castle |
Nottingham |
Stratham |
Area IX
Barrington |
Lee |
New Durham |
Strafford |
Dover |
Madbury |
Rochester |
|
Durham |
Middleton |
Rollinsford |
|
Farmington |
Milton |
Somersworth |
|
Area X
Atkinson |
Derry |
Pelham |
Sandown |
Chester |
Hampstead |
Plaistow |
Windham |
Danville |
Newton |
Salem |
|
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8443, eff 1-1-06;
ss by #8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23
He-M 505.06 Area Agency
Designation Procedures and Criteria.
(a) The bureau shall initiate the area agency
designation process by publishing a notice in a newspaper or newspapers of
area-wide distribution to convey information about:
(1) The role and responsibilities
of the area agency;
(2) Membership on the area
board; and
(3) The area agency application
and designation process, including the closing date for submission of
application materials required by (c) below.
(b) Existing boards of private, non-profit
agencies, including community mental health programs approved pursuant to RSA
135-C:10, may apply for designation as an area agency provided that the
requirements under RSA 171-A:18, He-M 505.04(g), and (d) below have been met.
(c) An applicant group shall submit the following
area agency application materials to the bureau:
(1) The name of the applicant
group’s contact person;
(2) Written assurances of
adherence to these rules and applicable federal and state laws and rules;
(3) A personal data summary for
each member of the applicant group, which shall:
a. Contain information
documenting the person's experience and knowledge as required by (d) below; and
b. Demonstrate that the person
is not excluded from board membership pursuant to He-M 505.04(g)(5);
(4) A description of the unmet
service needs of individuals and how the applicant group proposes to meet those
service needs; and
(5) A written proposal which
shall include a line item budget and a description of all services to be
provided.
(d) The members of the applicant group shall
collectively demonstrate, through the submission of personal data summaries as
required in (c)(3) above, experience in development and provision of services
as well as knowledge of the fiscal, legal, and management issues of services
and of the needs and abilities of individuals. The members of the applicant
group shall have a demonstrated commitment to community-based, individual -directed
services and have the capacity to meet the needs of individuals and families.
(e) The designation process shall be as follows:
(1) The commissioner shall
solicit and consider comments from individuals, their families, and other
stakeholders, such as local human services, educational, or advocacy
organizations, in the area as to the ability of the applicant group(s) to carry
out its responsibilities as stated in He-M 505.03 and He-M 505.04;
(2) The commissioner shall
review the materials submitted by each applicant group as specified in (c)
above and such information as is obtained from comments as provided in (e) (1)
above;
(3) The commissioner shall
select for site review the applicant group(s) that appear to be able to comply
with all applicable state and federal laws and rules;
(4) The applicant group that is
determined to be able to best comply with applicable deferral and state laws
and rules shall receive designation as the area agency within 75 days following
the date of the application deadline by the commissioner;
(5) Designation shall be for a
5-year term, unless revoked or suspended pursuant to He-M 505.07 or He-M 505.08
or unless an agency applies for redesignation in accordance with He-M 505.09;
(6) The commissioner shall
notify each applicant group that does not receive designation of the reason why
the applicant group was not designated;
(7) If there is no applicant
group selected for designation in the area, the commissioner shall notify each
applicant group and request that a second submission of application materials
occur within 30 days following notification by the commissioner;
(8) If no applicant group in
the area receives designation following the second submission of area agency
application materials, the commissioner shall reinitiate the application
procedure for designation of an area agency and either appoint an interim area
agency to operate in the area or designate department staff to temporarily operate
area agency services until a new area agency can be designated; and
(9) An applicant group denied
designation by the commissioner shall have the right to appeal pursuant to He-M
505.12.
(f) An agency that has had its status as an area
agency revoked in accordance with He-M 505.07, shall not be eligible to apply for designation
as a successor area agency for 5 years following the date of the revocation.
(g) In cases where 2 or more areas are
consolidated as a result of amendment of He-M 505.05, the commissioner shall
select one area agency as the designated area agency for the new consolidated
area using the criteria identified in He-M 505.09 (f)-(g). The area agency selected shall be one of the
area agencies previously designated to serve the areas being consolidated.
Source. #1647, eff 10-14-80; ss by #2020, eff 5-11-82;
ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90,
EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23 (formerly He-M 505.05)
He-M 505.07 Revocation of Designation.
(a) The bureau administrator shall monitor:
(1) The contract requirements, services, programs, and functions
provided by the area agency to assure that area agency services are operated in
accordance with the department rules and other applicable statutes, and federal
laws, regulations, and rules, contract provisions, and mission statement, and
the area plan in accordance with 505.04 (o)-(p); and
(2) The fiscal integrity, in accordance with contract requirements, of
the area agencies.
(b) In the event that the bureau administrator determines that the
area agency is not providing such services programs, supports, and functions in
accordance with said laws, rules, contract, plan, mission, or that the area
agency has not maintained fiscal integrity pursuant to contract requirements, the
bureau administrator shall send a written notice to the area agency and area
board specifying the nature of the deficiencies and the remedial action that is
requested.
(c) Notices issued pursuant to
(b) above shall specify when the remedial action shall be completed.
(d) In the event that the commissioner determines
that the area agency has not complied with the remedial action requested
pursuant to (b) above, the commissioner shall revoke the area agency’s
designation.
(e) The commissioner shall issue written notice
of revocation that specifies the reasons for the decision and its effective
date. The effective date of the decision shall be at least 90 days from the
date of said revocation notice.
(f) An area agency may request a revocation
hearing in accordance with He-M 505.12.
(g) In the event that the decision to revoke
designation is upheld following a revocation hearing, the commissioner shall
initiate the process to select a successor area agency according to He-M 505.06.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23 (formerly He-M 505.06)
He-M 505.08 Suspension.
(a) If the commissioner finds at any time that
the health, safety, or welfare of individuals or the public is endangered by
the continued operation of services by an area agency, the commissioner shall
order the immediate suspension of the area agency’s designation.
(b) The commissioner or their designee shall
conduct a hearing on the suspension within 10 days of its issue. Such a hearing
shall be conducted pursuant to RSA 541-A:31-36 and He-C 200, except as provided
in (f) below.
(c) The department shall send a notice to the
area agency specifying the reasons for the suspension and the time and place of
the hearing scheduled pursuant to (b) above.
(d) Within 10 days of the hearing, the
commissioner shall either revoke or reinstate the area agency’s designation.
(e) The area agency may appeal the commissioner’s
decision to a court of competent jurisdiction.
(f) In the event that the area agency waives its
right to a hearing on a decision to suspend designation, or that such decision
is upheld following a hearing, the commissioner shall initiate the process to
designate a successor area agency pursuant to He-M 505.06.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; amd by #8443, eff 1-1-06;
ss by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15; ss by #13842, eff 12-29-23 (formerly He-M 505.07)
He-M 505.09 Redesignation.
(a) Each area agency shall notify the bureau
administrator of its intent to be redesignated every 5 years, in accordance
with Table 505-2.
(b) Submission of notification
of the area agency’s intention to be redesignated shall cause the area agency’s
current designation to be effective until the bureau administrator issues a
decision pursuant to (i) below.
(c) If an area agency’s current designation is
due to expire earlier than the scheduled redesignation in Table 505-2, the
current designation shall be extended to remain effective until the scheduled
redesignation review is completed.
(d) Area agencies shall submit a comprehensive
self-assessment with the notification of intent to be redesignated, to outline the
area agency’s performance, within 180 days, but not less than 150 days, prior
to the expiration of its current redesignation according to Table 505-2 below:
Table 505-2, Redesignation Schedule
2024 and 2029 |
2025 and 2030 |
2026 and 2031 |
2027 and 2032 |
2028 and 2033 |
Region II |
Region III |
Region VII |
Region IV |
Region I |
Region V |
Region VI |
Region X |
Region IX |
Region VIII |
(e) The bureau
administrator shall review the agency’s self-assessment, department materials,
and feedback from provider agencies, providers, individuals, family members, area
citizens, advocacy and self-advocacy groups, and community groups regarding the
area agency’s past performance and current ability to coordinate access to a
comprehensive service delivery system.
(f) The bureau administrator shall consider the
area agency’s past and current performance in providing services, programs, and
functions to individuals and their families, including reviewing results and trends
identified from the annual governance reviews conducted pursuant to He-M 505.04(aa).
(g) An area agency shall be considered successful
and operating efficiently when it annually:
(1) Demonstrates, through its
services, programs, and functions, a commitment to a mission that embraces and
emphasizes active community membership and inclusion for persons with
disabilities;
(2) Demonstrates, through multiple means, its commitment to individual
rights, health promotion, and safety;
(3) Provides individuals and
families with information and supports to design and direct their services in accordance
with their needs, preferences, and capacities and to decide who will provide
them;
(4) Involves those who use its
services in area planning, system design, and development;
(5) Assesses and continuously
improves the quality of its services, and ensures that the recipients of
services are satisfied with the services that they receive;
(6) Demonstrates, through its
board of directors and management team, effective governance, administration,
and oversight of the area agency staff, provider agencies, and, if applicable,
subcontract agencies;
(7) Is fiscally sound, manages
resources effectively to support its mission, and utilizes generic community
resources and proactive supports in assisting people;
(8) Complies, along with its
subcontractors, if applicable, with all contract requirements and state and
federal requirements; and
(9) Achieves the goals
identified in its area plan and implements the recommendations made in its
previous redesignation report from the department, if applicable.
(h) Approval of an area agency’s request for
redesignation shall be granted if, based on the following information, the area
agency is found to be in compliance with (f)(1)-(9) above:
(1) Materials
collected as part of the redesignation process, which shall include, at a
minimum, the following:
a. Comments
solicited from individuals, family members, area citizens, provider agencies, providers,
advocacy and self-advocacy groups, and community groups demonstrating the area
agency’s ability to coordinate access to comprehensive services and provide
leadership in addressing the needs of individuals within its catchment region;
and
b. Information
to demonstrate that the area agency has complied with the requirements of He-M
202 with respect to implementation of recommendations; and
(2) Other
available documents which shall demonstrate:
a. Compliance with all department rules and other
applicable statutes and federal laws, regulations, and rules, and contract
requirements;
b. The results of the annual governance
reviews and any other announced or unannounced reviews;
c. Compliance with performing and documenting
Medicaid administration functions and claiming in accordance with 505.03; and
d. Corrective
action taken in response to any
department’s quality assurance review.
(i) The bureau administrator shall issue a report
redesignating or conditionally redesignating an area agency.
(j) An area agency shall respond to any
corrective action request included in a letter of redesignation.
Source. #1647, eff 10-14-80; ss by #2020, eff 5-11-82;
ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90,
EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23 (formerly He-M 505.08)
He-M 505.10 Conditional
Redesignation.
(a) If the area agency fails to meet the
redesignation criteria specified in He-M 505.09, the commissioner shall
redesignate the area agency on a conditional basis for a period of time not to
exceed l80 days.
(b) The commissioner shall specify, in writing,
conditions and time frames that shall be met by the area agency in order to be
eligible for redesignation.
(c) Department staff designated by the bureau
administrator shall review and issue a report regarding the area agency’s progress
toward compliance with the conditions identified pursuant to He-M 505.10 (b).
(d) At least 2 weeks prior to the expiration of
the conditional redesignation, the commissioner shall:
(l) Approve the application for
redesignation, effective as of the date of conditional redesignation, if all
conditions have been met within the required time frame; or
(2) Deny the application for
redesignation if all conditions have not been met within the required time
frame.
(e) Any corrective action not fully completed at
the time an application for redesignation is approved in accordance with (d)(1)
above shall be incorporated in the next area plan developed by the area agency
after the redesignation review.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23 (formerly He-M 505.09)
He-M 505.11 Denial of Redesignation.
(a) In those cases where the commissioner denies
an application for redesignation, the commissioner shall notify the area agency
in writing of the decision.
(b) Such a notice
described in (a) above, shall specify the reasons for the decision and its
effective date.
(c) The effective date
of the decision shall be at least 90 days from the date of the notice of denial.
(d) The area agency
shall have 20 days following the date of the notice to request a hearing on the
denial in accordance with He-M 505.12.
(e) In the event that a hearing request is not
made or the denial is upheld following a hearing, the commissioner shall
initiate the process to designate a successor area agency as outlined in He-M
505.06.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23 (formerly He-M 505.10)
He-M 505.12 Hearings.
(a) An area agency may request a hearing regarding
a denial of designation or redesignation or revocation of designation.
(b) A request for hearing shall be submitted to
the commissioner in writing within 20 days following the date of the
notification of denial or revocation.
(c) The commissioner or their designee shall
conduct a hearing in accordance with the procedures set forth in He-C 200
within 30 days of receipt of a request.
(d) Within 10 days of the hearing, the
commissioner shall grant or deny an application for designation or redesignation
or revoke or reinstate an area agency’s designation.
(e) The area agency may appeal the commissioner’s
decision to a court of competent jurisdiction.
Source. #1647, eff 10-14-80; ss by #2020, eff
5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff
1-15-90, EXPIRED: 1-15-96
New. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23 (formerly He-M 505.11)
He-M 505.13 Designation of Successor Area Agency.
(a) If the commissioner or designee upholds the
denial of designation or redesignation, suspension of designation, or
revocation, the commissioner shall initiate the process described in He-M 505.06
to designate a successor area agency.
(b) Pursuant to RSA 171-A:18, VII, the department
shall assume all or any part of the responsibilities of the area agency at any
time during which an area agency is not designated.
(c) Following the revocation of an area agency’s
designation, the department shall operate the services directly, enter a
contract with the agency for provision of certain services, or enter into
contracts with other area agencies to ensure the needs of individuals are met
by service providers that have the capacity to provide high quality services
pending the selection of a successor area agency.
Source. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23 (formerly He-M 505.12)
He-M 505.14 Waivers.
(a) An applicant, area agency, provider agency,
individual, guardian, or provider may request a waiver of specific procedures
outlined in He-M 505 by completing and submitting the form titled “NH Bureau of
Developmental Services Waiver Request” (October 2023) in accordance with
(b) and (c) below.
(b) A completed waiver request form shall be
signed by the individual or guardian, if applicable, and the area
agency’s executive director or designee recommending approval of the waiver.
(c) A waiver request shall be
submitted to the department via:
(1) Email at bds@dhhs.nh.gov; or
(2) By mail to:
Bureau of Developmental Services
Hugh J. Gallen State Office Park
105 Pleasant Street, Main Building
Concord, NH 03301
(d) No provision or procedure
prescribed by statute shall be waived.
(e) The request for a waiver
shall be granted by the commissioner or their designee within 30 days if the
alternative proposed by the requesting entity meets the objective or intent of
the rule and it:
(1) Does not negatively impact
the health or safety of the individual(s); and
(2) Does not affect the quality
of services to individuals.
(f) Upon receipt of approval of
a waiver request, the requesting entity’s subsequent compliance with the
alternative provisions or procedures approved in the waiver shall be considered
compliance with the rule for which waiver was sought.
(g) Waivers shall be granted in
writing for the minimum period necessary to accommodate the waiver request,
with a specific duration not to exceed 5 years except as in (h) and (j) below.
(h) Those waivers which relate
to other issues relative to the health, safety, or welfare of individuals that
require periodic reassessment shall be effective for the current designation
period only.
(i) Any waiver shall end with
the closure of the related program or service.
(j) A requesting entity may
request a renewal of a waiver from the bureau.
Such request shall be made at least 90 days prior to the expiration of a
current waiver.
Source. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff
10-21-06, EXPIRED: 4-19-07
New. #8928, eff 6-30-07; ss by #10916, eff 8-26-15;
ss by #13842, eff 12-29-23; ss by #13842, eff 12-29-23 (formerly He-M 505.13)
PART He-M 506 STAFF QUALIFICATIONS AND STAFF DEVELOPMENT
REQUIREMENTS FOR DEVELOPMENTAL SERVICE AGENCIES
Statutory
Authority: New Hampshire RSA 171-A:3;
18, IV; 137-K:3, IV
He-M 506.01 Purpose. The purpose of these rules is to outline the
minimum qualifications of provider agency staff, and the training requirements
for such staff.
Source. #2033, eff 6-7-82; ss by #2679, eff 4-18-84;
ss by #5047, eff 1-18-91, EXPIRED: 1-18-97
New. #6645, eff 12-2-97, EXPIRED: 12-2-05
New. #8604, eff 4-11-06; ss by #10528, eff 3-1-14
He-M 506.02 Definitions.
(a)
“Acquired brain disorder” means a disruption in brain functioning that:
(1) Is not
congenital or caused by birth trauma;
(2) Presents
a severe and life-long disabling condition which significantly impairs a
person's ability to function in society;
(3) Occurs
prior to age 60;
(4) Is attributable
to one or more of the following reasons:
a. External trauma to the brain as a result of:
1. A motor vehicle incident;
2. A fall;
3. An assault; or
4. Another related traumatic incident or
occurrence;
b. Anoxic or hypoxic injury to the brain such as
from:
1. Cardiopulmonary arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases such as encephalitis and
meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; and
h. Other neurological disorders such as
Huntington's disease or multiple sclerosis which predominantly affect the
central nervous system; and
(5) Is
manifested by one or more of the following:
a. Significant decline in cognitive functioning
and ability; or
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits.
(b)
“Area agency” means “area agency” as defined under RSA 171-A:2, I-b.
(c) “Bureau of elderly and adult services (BEAS) state
registry” means a database created and maintained pursuant to RSA 161-F:49 and
He-E 720 containing information on founded reports of abuse, neglect, or
exploitation of incapacitated adults by a paid or volunteer caregiver,
guardian, or agent acting under the authority of any power of attorney or any
durable power of attorney.
(d)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(e)
“Developmental disability” means “developmental disability” as defined
in RSA 171‑A:2, V, namely, “a disability:
a. Which is
attributable to an intellectual disability, cerebral palsy, epilepsy, autism or
a specific learning disability or any other condition of an individual found to
be closely related to an intellectual disability as it refers to general
intellectual functioning or impairment in adaptive behavior or requires treatment
similar to that required for persons with an intellectual disability; and
b. Which originates
before such individual attains age 22, has continued or can be expected to
continue indefinitely, and constitutes a severe handicap to such individual's
ability to function normally in society.”
(f)
“Family” means a group of 2 or more persons related by ancestry,
marriage or other legal arrangement.
(g)
“Health Risk Screening Tool (HRST)” means the 2009 edition of the Health
Risk Training Tool, available as noted in Appendix A, which is a web-based rating
instrument used for performing health risk screenings on individuals in order
to:
(1) Determine an individual’s vulnerability
regarding potential health risks; and
(2) Enable the early identification of health
issues and monitoring of health needs.
(h)
“Individual” means any person with a developmental disability or
acquired brain disorder who receives, or has been found eligible to receive,
area agency services.
(i) “Provider” means a person
receiving any form of remuneration for the provision of services to an individual.
(j)
“Provider agency” means an area agency or an entity under contract with
an area agency that is responsible for providing services to individuals.
(k)
“Staff” means provider agency staff who provide direct supports to
people who have developmental disabilities or acquired brain disorders,
including, at a minimum, service coordinators, clinical staff, and personal
care staff.
(l)
“Staff development” means education and training designed to improve the
competencies of provider agency staff.
(m)
“Supports Intensity Scale” means the 2004 edition of the Supports
Intensity Scale, available as noted in Appendix A, which is an assessment tool
intended to assist in service planning by measuring the individual’s support
needs in the areas of home living, community living, lifelong learning,
employment, health and safety, social activities, and protection and advocacy. The tool uses a formal rating scale to
identify the type of supports needed, frequency of supports needed, and daily
support time.
Source. #2033, eff 6-7-82; ss by #2679, eff 4-18-84;
ss by #5047, eff 1-18-91, EXPIRED: 1-18-97
New. #6645, eff 12-2-97, EXPIRED: 12-2-05
New. #8604, eff 4-11-06; ss by #10528, eff 3-1-14
He-M 506.03 Minimum Staff Qualifications.
(a)
Provider agency staff shall meet the qualifications for and conditions
of employment identified in He-M 507, He-M 510, He-M 513, He-M 518, He-M 521,
He-M 524, He-M 1001, and He-M 1201.
(b)
Each applicant for employment shall:
(1) Meet the educational qualifications, or the
equivalent combination of education and experience, identified in the job
description;
(2) Meet professional certification and licensure
requirements of the position;
(3) Meet the motor vehicle licensure requirement
identified in the job description;
(4) Either:
a. Present documentation of a tuberculosis (TB)
test performed within the past 6 months; or
b. Undergo a TB test prior to employment; and
(5) If a test referenced in (4) above is
positive, provide evidence of follow-up conducted in accordance with the
Centers for Disease Control and Prevention “Guidelines for Preventing the
Transmission of Mycobacterium
tuberculosis in Health-Care Settings, 2005,” available as noted in Appendix
A.
(c)
All staff shall be at least 18 years of age.
(d)
Prior to a person working directly with an individual, the provider
agency, with the consent of the person, shall:
(1) Obtain at least 2 references for the person;
(2) Complete, at a minimum, a New Hampshire
criminal records check no more than 30 days prior to hire;
(3) If a person’s primary residence is out of
state, complete a criminal records check for their state of residence;
(4) If a person has resided in New Hampshire for
less than one year, complete a criminal records check for their previous state
of residence; and
(5) Complete a BEAS state registry check no more
than 30 days prior to hire.
(e)
Except as allowed in (f)-(g) below, the provider agency shall not hire a
person:
(1) Who has a:
a. Felony conviction; or
b. Any misdemeanor conviction involving:
1. Physical or sexual assault;
2. Violence;
3. Exploitation;
4. Child pornography;
5. Threatening or reckless conduct;
6. Theft;
7. Driving under the influence of drugs or
alcohol; or
8. Any other conduct that represents evidence of
behavior that could endanger the well-being of an individual; or
(2) Whose name is on the BEAS state registry.
(f)
A provider agency may hire a person with a criminal record listed in
(e)(1)a. or b. above for a single offense that occurred 10 or more years ago in
accordance with (g) and (h) below. In
such instances, the individual, his or her guardian if applicable, and the area
agency shall review the person’s history prior to approving the person’s
employment.
(g)
Employment of a person pursuant to (f) above shall only occur if such
employment:
(1) Is approved by the individual, his or her
guardian if applicable, and the area agency;
(2) Does not negatively impact the health or
safety of the individual(s); and
(3) Does not affect the quality of services to
individuals.
(h) Upon hiring a person pursuant to (f) above,
the provider agency shall document and retain the following information in the
individual’s record:
(1) Identification of the region, according to
He-M 505.04, in which the provider agency is located;
(2) The date(s) of the approvals in (f) above;
(3) The name of the individual or individuals for
whom the person will provide services;
(4) The name of the person hired;
(5) Description of the person’s criminal offense;
(6) The type of service the person is hired to
provide;
(7) The provider agency’s name and address;
(8) The certification number and expiration date
of the certified program, if applicable;
(9) A full explanation of why the provider agency
is hiring the person despite the person’s criminal record;
(10) Signature of the individual(s), or of the
legal guardian(s) if applicable, indicating agreement with the employment and
date signed;
(11) Signature of the staff person who obtained
the individual’s or guardian’s signature and date signed;
(12) Signature of the area agency’s executive
director or designee approving the employment; and
(13) The signature and phone number of the person
being hired.
(i)
Personnel records, including background information relating to a staff
person’s qualifications for the position held, shall be maintained by the
provider agency for a period of 7 years after that staff person’s employment
termination date.
Source. #2033, eff 6-7-82; ss by #2679, eff 4-18-84;
ss by #5047, eff 1-18-91, EXPIRED: 1-18-97
New. #6645, eff 12-2-97, EXPIRED: 12-2-05
New. #8604, eff 4-11-06; ss by #10528, eff 3-1-14
He-M 506.04 Policy and Procedure Requirements. Each provider agency shall establish and
implement written personnel and staff development policies which shall
specifically address the following:
(a)
Non-discrimination on the basis of:
(1) Race;
(2) Color;
(3) Sex;
(4) Creed;
(5) National origin;
(6) Age;
(7) Marital status;
(8) Familial status;
(9) Sexual orientation; or
(10) Physical or mental disability;
(b) Job descriptions, including conditions of
employment;
(c)
Staff performance reviews; and
(d)
Individual staff development plans.
Source. #2033, eff 6-7-82; ss by #2679, eff 4-18-84;
ss by #5047, eff 1-18-91; amd by #5322, eff 1-31-92; ss by #6645, eff 12-2-97;
EXPIRE: 12-2-05
New. #8604, eff 4-11-06; ss by #10528, eff 3-1-14
He-M 506.05 Staff Development Requirements.
(a)
Each person employed by a provider agency shall participate in the
writing and implementation of an individual staff development plan with his or
her supervisor at least annually.
(b)
The staff development plan shall be kept in the employee’s personnel file.
(c)
The staff development plan shall include the following:
(1) An assessment of current work-related
competencies; and
(2) Methods identified to achieve improvement in
competencies, including:
a. Education;
b. Training, or
re-training; and
c. Other staff supports
that have been identified.
(d)
Within the first month of employment, a provider agency shall train each
employee in:
(1) An overview of the rights of persons who
receive services, as described in He-M 202 and He-M 310; and
(2) Developing an understanding of the stigmas,
negative labels and common life experiences of people with disabilities
including how individuals utilize behavior as communication.
(e)
Prior to working directly with an individual, staff shall be trained in
and, pursuant to (g) below, demonstrate an understanding of the following
information regarding the individual:
(1) Personal profile;
(2) Goals;
(3) Specific health-related requirements,
including:
a. All current medical conditions, medical history,
and routine and emergency protocols;
b. Any special nutrition, hydration,
elimination, personal hygiene, oral health or ambulation needs; and
c. Any special, cognitive, mental health or
behavioral needs;
(4) Information the family, and guardian if
applicable, believe would be helpful to the service provision process;
(5) Emergency contact information;
(6) Safety plan;
(7) Behavior or risk management plan;
(8) HRST information pertinent to supporting the
individual;
(9) SIS information pertinent to supporting the
individual;
(10) Any other information needed to ensure the
individual’s health and safety needs are understood; and
(11) Any information in the service agreement not
specified in (1)-(10) above.
(f)
Staff with no prior experience providing services directly to individuals
shall receive direct oversight and support during at least the first 16 hours
of providing services.
(g)
Prior to staff working directly with an individual and annually
thereafter, supervisors shall ask each staff to demonstrate, through examples,
their understanding of the information presented pursuant to (e) above.
(h)
At least monthly, supervisors or their designees shall conduct
unannounced visits to staff at community locations while they are providing services
for individuals. The purpose of the
visits shall be to assure that services are provided in accordance with each
individual's service agreement.
(i)
Staff shall be re-trained annually in an overview of the rights of
persons who receive services, as described in He-M 202 and He-M 310. Re-training shall include examples of rights
violations.
(j)
A provider agency shall train staff in the following areas within the
first 6 months of employment:
(1) An overview of developmental disabilities and
acquired brain disorders, which shall include:
a. An overview of the different types of developmental
disabilities and acquired brain disorders and their causes;
b. An overview of the local and state service
delivery system; and
c. An overview of professional services and
technologies including therapies, assistive technologies and environmental modifications necessary to achieve individuals' goals at
home, in the community, in the workplace and in recreation or leisure
activities;
(2) An overview of conditions promoting or
detracting from the quality of life that individuals enjoy, which shall provide staff the competencies necessary to:
a. Support individuals to obtain and maintain
valued social roles;
b. Support individuals to build relationships
with their families, neighbors, co-workers and other community members;
c. Create and enhance opportunities for
individuals to:
1. Increase their presence in the life of their
local communities; and
2. Increase the ways in which they contribute to
their communities;
d. Support individuals to have as much control
as possible over their own lives;
e. Build individuals’ skills, strengths and
interests that are functional and meaningful in natural community environments;
f. Create supports that enable individuals to
explore and participate in a wide variety of community activities and
experiences in settings that are available to the general public; and
g. Support individuals to gain as much independence
as possible;
(3) Methods to assist individuals with challenging
behaviors utilizing positive behavioral supports as described in He-M 1001.07
(d);
(4) Understanding, and assisting individuals to
manage behavior that derives from neurological compromises or limitations;
(5) Techniques to:
a. Facilitate social relationships;
b. Enhance skills that improve everyday living
and promote independence; and
c. Teach, coach and mentor individuals to learn
skills that maximize independence;
(6) Basic health and safety practices related to:
a. Personal wellness;
b. Success in living, working and recreating in
the community; and
c. An understanding of the importance of common
signs and symptoms of illness;
(7) Training relative to supporting individuals
in employment pursuant to He-M 518, as appropriate;
(8) Skills necessary to support individuals and
their families to:
a. Make their own decisions;
b. Advocate for themselves; and
c. Create their own social networks;
(9) Any trainings specified in an individual’s
service agreement; and
(10) Training in orienting individuals to fire
safety and emergency evacuation procedures.
Source. #2033, eff 6-7-82; ss by #2679, eff 4-18-84;
ss by #5047, eff 1-18-91, EXPIRED: 1-18-97
New. #6645, eff 12-2-97, EXPIRED: 12-2-05
New. #8604, eff 4-11-06; ss by #10528, eff 3-1-14
He-M 506.06 Waivers.
(a) An
applicant, area agency, provider agency, individual, guardian, or provider may
request a waiver of specific procedures outlined in He-M 506 using the form
titled “NH Bureau of Developmental Services Waiver Request” (September
2013 edition).
The area agency shall submit the request in writing to the bureau
administrator.
(b)
A completed waiver request form shall be signed by:
(1) The individual or guardian indicating
agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c) A waiver request shall be submitted to:
Office
of Client and Legal Services
Hugh
J. Gallen State Office Park
105 Pleasant Street, Main Building
Concord,
NH 03301
(d)
No provision or procedure prescribed by statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner or his or
her designee within 30 days if the alternative proposed by the requesting
entity meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not affect the quality of services to
individuals.
(f)
Upon receipt of approval of a waiver request, the requesting entity’s
subsequent compliance with the alternative provisions or procedures approved in
the waiver shall be considered compliance with the rule for which waiver was sought.
(g)
Waivers shall be granted in writing for a specific duration not to
exceed 5 years except as in (h) and (j) below.
(h) Those waivers which relate to other issues
relative to the health, safety or welfare of individuals that require periodic
reassessment shall be effective for the current certification period only.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
A requesting entity may request a renewal of a waiver from the
bureau. Such request shall be made at
least 90 days prior to the expiration of a current waiver.
Source. #6645, eff 12-2-97, EXPIRED: 12-2-05
New. #8604, eff 4-11-06; ss by #10528, eff 3-1-14
PART He-M 507 COMMUNITY PARTICIPATION SERVICES
Statutory
Authority: New Hampshire RSA 171-A:3; 171-A:18,
IV; 137-K:3, IV
He-M 507.01 Purpose. The purpose of these rules is to establish
standards for certified community participation services as part of a
comprehensive array of community-based services for persons with developmental
disabilities or acquired brain disorders that:
(a)
Assist the individual to attain, improve, and maintain a variety of life
skills, including vocational skills;
(b)
Emphasize, maintain and broaden the individual’s opportunities for
community participation and relationships;
(c)
Support the individual to achieve and maintain valued social roles, such
as of an employee or community volunteer;
(d)
Promote personal choice and control in all aspects of the individual’s
life and services, including the involvement of the individual, to the extent
he or she is able, in the selection, hiring, training, and ongoing evaluation
of his or her primary staff and in determining the quality of services; and
(e)
Are provided in accordance with the individual’s service agreement and
goals and desired outcomes.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff
8-4-89; EXPIRED: 8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05, EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13;
ss by #10426, eff 10-1-13
He-M 507.02 Definitions. The words and phrases used in these rules
shall mean the following:
(a)
“Acquired brain disorder” means a disruption in brain functioning that:
(1) Is not congenital or caused by birth trauma;
(2) Presents a severe and life-long disabling
condition which significantly impairs a person’s ability to function in
society;
(3) Occurs prior to age 60;
(4) Is attributable to one or more of the
following reasons:
a. External trauma to the brain as a result of:
1. A motor vehicle incident;
2. A fall;
3. An assault; or
4. Another related traumatic incident or
occurrence;
b. Anoxic or hypoxic injury to the brain such as
from:
1. Cardiopulmonary arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases such as encephalitis and
meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; or
h. Other neurological disorders such as
Huntington's disease or multiple sclerosis which predominantly affect the
central nervous system; and
(5) Is manifested by one or more of the
following:
a. Significant decline in cognitive functioning
and ability; and
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits.
(b) “Area agency” means “area agency” as defined
under RSA 171-A:2, I-b, namely, “an entity established as a nonprofit
corporation in the state of New Hampshire which is established by rules adopted
by the commissioner to provide services to developmentally disabled persons in
the area.”
(c)
“Basic living skills” means activities accomplished each day to acquire,
improve, or maintain independence in daily life.
(d)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(e)
“Centralized service site” means a location operated by a provider
agency where individuals receive community participation services for more than
one hour per day.
(f)
“Certification” means the written approval by the bureau of health
facilities administration for the operation of community participation services
in accordance with the requirements set forth in He-M 507.
(g)
“Community participation services”, also called “day services” elsewhere
in He-M 500 and He-M 1001, means habilitation, assistance, and instruction
provided to individuals that:
(1) Improve or maintain their performance of basic
living skills;
(2) Offer vocational and community activities, or
both;
(3) Enhance their social and personal
development;
(4) Include consultation services, in response to
individuals’ needs, and as specified in service agreements, to improve or
maintain communication, mobility, and physical and psychological health; and
(5) At a minimum, meet the needs and achieve the
desired goals and outcomes of each individual as specified in the service
agreement.
(h)
“Covered services” means community participation services described
pursuant to He-M 507.04 as reimbursable under the Medicaid program or through
grants from the bureau.
(i)
“Department” means the department of health and human services.
(j)
“Developmental disability” means “developmental disability” as defined
in RSA 171‑A:2, V, namely, “a disability:
(a) Which is attributable to an intellectual
disability, cerebral palsy, epilepsy, autism or a specific learning disability,
or any other condition of an individual found to be closely related to an
intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability; and
(b) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe handicap to such individual's ability to function normally
in society.”
(k)
“Exploitation” means “exploitation” as defined in RSA 161-F:43, IV.
(l)
“Family” means a group of 2 or more persons related by ancestry,
marriage, or other legal arrangement.
(m)
“Health assessment” means an evaluation of an individual’s health status
done by a physician or other licensed practitioner for the purpose of making
recommendations regarding strategies for promoting and maintaining optimum
health.
(n)
“Health Risk Screening Tool (HRST) (2009 edition)”, available as noted
in Appendix A, means a web-based rating instrument used for performing health
risk screenings on individuals in order to:
(1) Determine an individual’s vulnerability
regarding potential health risks; and
(2) Enable the early identification of health
issues and monitoring of health needs.
(o)
“Home and community‑based care waiver” means the waiver of
sections 1902 (a) (10) and 1915 (c) of the Social Security Act which allows the
federal Medicaid funding of long‑term services for persons in non‑institutional
settings who are elderly, disabled, or chronically ill.
(p)
“Individual” means any person with a developmental disability or
acquired brain disorder who receives, or has been found eligible to receive,
area agency services.
(q)
“Personal development” means supporting or increasing an individual's
capacity to make choices, to communicate interests and preferences, and to have
sufficient opportunities for exploring and meeting those interests.
(r)
“Personal profile” means a narrative description prepared pursuant to
He-M 503.11 (f)(1) a. 1. that includes:
(1) A personal statement from the individual and
those who know him or her best that summarizes the individual’s strengths and
capacities, communication and learning style, challenges, needs, interests, and
any health concerns, as well as the individual’s hopes and dreams;
(2) A personal history covering significant life
events, relationships, living arrangements, health, use of assistive
technology, and results of evaluations which contribute to an understanding of
the individual’s needs;
(3) A review of the past year that:
a. Summarizes
the individual’s:
1. Personal achievements;
2. Relationships;
3. Degree of community involvement;
4. Challenging issues or behavior;
5. Health status and any changes in health; and
6. Safety considerations during the year;
b. Addresses the
previous year’s desired goals and outcomes with level of success and, if applicable,
identifies any obstacles encountered;
c. Identifies
the desired goals and outcomes of the individual for the coming year;
d. Identifies
the type and amount of services the individual receives and the support
services provided under each service category;
e. Identifies
the individual’s health needs;
f. Identifies
the individual’s safety needs;
g. Identifies
any follow-up action needed on concerns and the persons responsible for the
follow-up; and
h. Includes a
statement of the individual’s and guardian’s satisfaction with services;
(4) An attached work history of the individual’s
paid employment and volunteer positions, as applicable, that includes:
a. Dates of
employment;
b. Type of
work;
c. Hours worked
per week; and
d. Reason for
leaving, if applicable; and
(5) A reference to sensitive historical
information in other sections of the record when the individual or guardian, as
applicable, prefers not to have this included in the profile.
(s)
“Primary staff” means staff who are regularly assigned to provide
services to specific individuals.
(t)
“Provider” means a person receiving any form of remuneration for the
provision of services to an individual.
(u)
“Provider agency” means an area agency or an entity under contract with
an area agency that is responsible for providing community participation
services to individuals.
(v)
“Risk management plan” means a person-centered document that describes
the services, supports, approaches and guidelines to be utilized to meet the
individual’s needs and mitigate risks to community safety and which is
consistent with the service guarantees and protections articulated in He-M 503.
(w)
“Service agreement” means a written agreement between an individual or
guardian and the area agency that describes the services that the individual
will receive and constitutes an individual service agreement as defined in RSA
171-A:2, X. The term includes a basic
service agreement for all individuals who receive services and an expanded
service agreement for those who receive more complex services pursuant to He-M
503.11.
(x)
“Service coordinator” means a person who is chosen or approved by an individual
and his or her guardian and designated by the area agency to organize, facilitate
and document service planning and to negotiate and monitor the provision of the
individual’s services and who is:
(1) An area agency service coordinator, family support
coordinator, or any other area agency or provider agency employee;
(2) A member of the individual’s family;
(3) A friend of the individual; or
(4) Another person chosen to represent the
individual.
(y)
“Sheltered workshop” means a program that provides a segregated service
environment where the contract objectives of the provider agency are the
primary focus and goal.
(z)
“Supports Intensity Scale (2004 edition)”, available as noted in
Appendix A, means an assessment tool intended to assist in service planning by
measuring the individual’s support needs in the areas of home living, community
living, lifelong learning, employment, health and safety, social activities,
and protection and advocacy. The tool uses a formal rating scale to identify
the type of supports needed, frequency of supports needed, and daily support
time.
(aa)
“Systematic, therapeutic, assessment, respite and treatment (START)”
means the model of service supports that is intended to optimize independence,
treatment, and community living for individuals with developmental disabilities
and mental health needs.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED:
8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05, EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13
He-M 507.03 Service Principles.
(a) All community participation services shall be
designed to:
(1) Support the individual’s participation in a
variety of integrated community activities and settings;
(2) Assist the individual to be a contributing
and valued member of his or her community through vocational and volunteer
opportunities;
(3) Meet the individual’s needs, goals, and
desired outcomes, as identified in his or her service agreement, related to
community opportunities for volunteerism, employment, personal development,
socialization, recreation, communication, mobility, and personal care;
(4) Help the individual to achieve more independence
in all aspects of his or her life by learning, improving, or maintaining a
variety of life skills, such as:
a. Traveling safely in the community;
b. Managing personal funds;
c. Participating in community activities; and
d. Other life skills identified in the service
agreement;
(5) Promote the individual’s health and safety;
(6) Protect the individual’s right to freedom
from abuse, neglect, and exploitation; and
(7) Provide opportunities for the individual to
exercise personal choice and independence within the bounds of reasonable
risks.
(b) Community participation services shall be
primarily provided in community settings outside of the home where the
individual lives.
(c) An individual or guardian may select any
person, any provider agency, or another area agency as a provider to deliver
the community participation services identified in the individual’s service
agreement.
(d) All providers shall:
(1) Comply with the rules pertaining to community
participation services;
(2) Enter into a contractual agreement with the
area agency; and
(3) Operate within the limits of funding
authorized by the agreement.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED:
8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05; amd by #8545, eff 1-24-06;
paras (a)-(g) and (i)-(q) expired on 4-16-13; ss by #10320, INTERIM, eff
4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13
He-M 507.04 Covered Services.
(a)
All community participation services shall be designed and provided in
accordance with the individual’s specific needs, interests, competencies, and
learning style, as described in the individual’s service agreement and personal
profile.
(b)
The following services shall be covered:
(1) Instruction and assistance to learn, improve,
or maintain:
a. Social and safety skills in different
community settings;
b. Decision-making regarding choice of and
participation in community activities;
c. Life skills as applied to community-based
activities, such as purchasing items and managing personal funds;
d. Good nutrition and healthy lifestyle;
e. Self-advocacy and rights and responsibilities
as citizens; and
f. Any other skill identified by the individual
or guardian during service planning and related to the individual’s
participation in, or contribution to, his or her community;
(2) Supports to identify and develop the
individual’s interests and capacities related to securing employment opportunities,
including internships;
(3) Services related to job development and
on-the-job training;
(4) Assistance in finding and maintaining volunteer
positions;
(5) Supports related to enabling the individual
to explore, and participate in, a wide variety of community activities and
experiences in settings that are available to the general public;
(6) Consultation services as specified in the
service agreement to improve or maintain the individual’s communication,
mobility, and physical and psychological health and well-being; and
(7) Transportation that is:
a. Related to community participation
services, including travel from the individual’s residence to locations where
the community participation service activities are taking place; or
b. Travel from the individual’s residence to employment
or volunteer positions described in He-M 507.05 (a)(3) below.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED:
8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05, EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13
He-M 507.05 Non‑Covered Services.
(a)
The following services shall not be covered by community participation
services funding provided by the bureau or the Medicaid home- and community‑based
care waiver:
(1) Custodial care programs provided only to
maintain an individual’s basic welfare;
(2) Sheltered workshops;
(3) Employment or volunteer positions where the
individual is:
a. Being solely supported by persons who are not
providers; and
b. Not receiving any services from a provider
agency at those locations; and
(4) Educational services or education programs for
individuals under 21 years of age for which school districts are responsible.
(b) When the
community participation services for an individual are phased out at a volunteer
or job site and the individual begins to be supported by non-paid persons
exclusively, as described in (a)(3) above, the provider agency may include such
an arrangement as a part of its billable community participation service for a
maximum of another 120 days. The
staffing resources freed up from such an arrangement may be used to support the
individual in other activities or need areas identified in the individual’s
service agreement.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; amd by #5864, eff 7-1-94; EXPIRED: 8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05, EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13
He-M 507.06 Certification.
(a)
To be eligible for reimbursement by the bureau or by Medicaid for
community participation services provided to individuals, community
participation services shall be certified by the department.
(b)
If a provider agency wishes to furnish community participation services
to 3 or more persons who have not been found eligible for area agency services,
the provider agency shall be licensed as an adult day program in accordance with
RSA 151 and He-P 818.
(c)
An entity seeking certification or recertification to provide community
participation services shall submit an application to:
Bureau
of Health Facilities Administration (BHFA)
Hugh J. Gallen State Office Park
129 Pleasant Street, Brown Building
Concord, NH 03301
(d)
Application materials shall include the following:
(1) A completed “Request for Certification of
Community Residence and/or Individual Community Participation Services
Provider” application (September 2013 edition);
(2) A written description of the proposed staffing
pattern necessary to provide services pursuant to He-M 507.04;
(3) The names, titles, qualifications and
relevant experience of all staff members, in accordance with He-M 506.03 and
He-M 507.10;
(4) Written administrative policies and
procedures, which shall comply with He-M 507.08(b); and
(5) If the community participation services are
provided in a centralized service site, a copy of a life safety report which
shall:
a. Have been completed no more than 90 days prior
to submission; and
b. Include:
1. The name and address of the provider agency;
2. The date of
inspection and certification by the local fire inspector that the centralized
service site, if applicable, complies with local fire safety codes;
3. The maximum number of individuals authorized
to receive services; and
4. The signature, title, and professional
affiliation of the local fire inspector.
(e)
For a provider agency requesting initial certification, certification
shall be granted for 90 days from the date the department receives all required
information if the provider agency meets the requirements of, or demonstrates
the capacity to meet the requirements of, He-M 507.04, He-M 507.08 (b), and
He-M 507.10.
(f)
An initial certification review shall be conducted at the provider
agency location by BHFA within 90 days of the effective date of the initial
certificate for the purposes of determining whether or not the community
participation services are in compliance with these rules.
(g)
Initial certification shall be granted from the effective date of the
initial certificate until the last day of the twelfth month following
certification when the provider agency verifies that:
(1) Any necessary corrective action has been
taken; and
(2) The services conform with all applicable
rules adopted by the commissioner.
(h)
For community participation services that are applying for
recertification, BHFA shall conduct a certification review prior to the
expiration date of the certificate. The
current certification shall be effective until recertification has been granted
or denied or unless the current certification is revoked.
(i)
A community participation service program applying for recertification
shall submit a completed application 60 days prior to the expiration of the
certificate.
(j)
The renewal period for certificates shall be one year from the
expiration date of the previous certificate for:
(1) Community participation service programs
certified for 51 or more individuals; and
(2) Community participation service programs certified
for 50 or fewer individuals with 3 or more deficiencies.
(k)
The renewal period for certificates shall be 2 years from the expiration
date of the previous certificate for community participation service programs
certified for 50 or fewer individuals with 2 or fewer deficiencies.
(l)
When a renewal certificate is issued for a period of 2 years, the
provider agency holding the certificate shall conduct a quality assurance
review one year following the issuance to ensure that the community participation
service program remains in compliance with all applicable rules.
(m)
When BHFA staff conduct the 2-year certification review:
(1) If the community participation service
program has documentation of a review pursuant to (l) above, BHFA staff shall:
a. Review such documentation;
b. Cite any deficiency noted during the
agency-conducted quality assurance review that has not been addressed; and
c. Review the community participation service
program’s compliance for the previous year; or
(2) If the community participation service program
lacks documentation of a review pursuant to (l) above, BHFA staff shall:
a. Cite this as a deficiency; and
b. Hold the entire 2-year period subject to review.
(n)
Notwithstanding (m) (1) above, any documentation maintained by a
community participation service program during its most recent 2-year
certification period shall be open to review by BHFA staff for compliance with
applicable department rules.
(o)
If deficiencies were cited in the inspection
report, within 21 days of the date of issuance of the report the community
participation service program shall submit a written
plan of correction or submit information demonstrating that the deficiency(ies)
did not exist. The department shall
evaluate any submitted information on its merits and render a written decision
on whether a written plan of correction is necessary.
(p)
The department shall, within 45 days:
(1) Accept a plan of correction or other information
submitted pursuant to (o) above if:
a. The plan:
1. Addresses each identified deficiency in a
manner which achieves full compliance with rules cited in the inspection
report;
2. Does not create
another violation of statute or rule as the result of its implementation;
3. States a completion date; and
4. Identifies a plan for how each deficiency
will be prevented in the future; or
b. The information submitted proves that the
deficiency was cited erroneously; or
(2) Reject a plan of correction or other
information submitted pursuant to (o) above that fails to meet the criteria in
(1) above.
(q)
If the proposed plan of correction is rejected, the department shall
notify the provider agency in writing of the reason(s) for rejection.
(r)
Within 10 business days of the date of the written notice under (q)
above, the provider agency shall submit a revised plan of correction that
includes proposed alternatives that address the reason(s) for rejection.
(s)
The department shall either accept or reject the revised plan in
accordance with (p) above. If the
revised plan of correction is rejected, the department shall deny the
certification request. The provider
agency may appeal the denial pursuant to He-M 507.15.
(t)
The department shall renew a certificate if it determines that:
(1) No deficiencies exist; or
(2) The plan of correction complies with (p) (1)
a. above.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED:
8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05, EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.03)
He-M 507.07 Operating Requirements.
(a)
Each individual shall have a written service agreement that includes
goals and desired outcomes and activities specific to his or her community participation
services. Each service agreement shall
meet the requirements of He-M 503.11.
(b)
For each individual receiving community participation services, the
annual service planning meeting shall include a discussion of employment and
volunteer opportunities.
(c)
Individual community participation services shall be designed in
accordance with He-M 503.08 and He-M 503.11.
(d)
Review of each individual’s progress with respect to goals and outcomes
shall be conducted and documented as specified in the service agreement, but
not less than quarterly.
(e)
Participation in all community participation services shall be
voluntary.
(f)
Any person may make a recommendation for termination of services in
accordance with He-M 503.16.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED:
8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05; amd by #8545, eff 1-24-06;
paras (a)-(d) and (f) expired on 4-16-13; ss by #10320, INTERIM, eff 4-25-13,
EXPIRES: 10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.06)
He-M 507.08 Organization and Administration.
(a) The community participation services
director shall be responsible for the administration of community participation services and the hiring, training, and supervision
of community participation services staff.
(b)
Provider agencies shall have written policies and procedures that
address the following:
(1) The provision of covered services;
(2) Emergency plans, which shall minimally
include:
a. Procedures to follow while at a service site,
in a vehicle, or in the community in case of:
1. Behavioral or medical emergencies of an
individual; or
2. Fire or severe weather; and
b. If individuals gather at a centralized
service site to receive services, an emergency evacuation plan including
provisions in compliance with the following:
1. Each individual shall be oriented to
evacuation procedures upon starting services;
2. If the service site has been evacuated in 3
minutes or less during each of 6 consecutive monthly drills, the provider
agency shall thereafter conduct a drill at least once quarterly;
3. If the service site has not been evacuated in
3 minutes or less during each of 6 consecutive monthly drills, the provider
agency shall conduct monthly drills;
4. For each individual unable to evacuate in 3
minutes or less, the provider agency shall implement a specific evacuation
plan;
5. Evacuation drills shall be held at varied
times of the day;
6. A written record of each drill shall be kept
on file by the provider agency;
7. Staff shall be trained in all aspects of
evacuation procedures; and
8. Staff who conduct training pursuant to 7.
above shall document such training;
(3) A policy for the administration of
medication, which shall comply with the requirements of He-M 1201;
(4) A policy on individual rights in accordance
with He-M 202 and He-M 310; and
(5) If individuals gather at a centralized
service site to receive services, a policy which ensures compliance with applicable
local and state health, zoning, building, and fire codes and requires
documentation of compliance with fire codes.
(c)
Record keeping shall be as follows:
(1) Records shall comply with the requirements of
He-M 310, rights of individuals receiving developmental services in the
community, and He-M 503.10–503.11, service planning and service agreements;
(2) The provider agency shall maintain a separate
record for each individual and records regarding administration of services;
(3) Each individual’s record shall have an
administrative and a service component as described in (d) and (e) below; and
(4) Attendance records, either individual or
collective, shall be kept at the administrative offices of the provider agency
and at the area agency.
(d) The administrative component of each
individual’s record shall include, for that individual, at least the following:
(1) Personal and identifying information,
including:
a. Name;
b. Address;
c. Phone number;
d. Photo or physical description;
e. Date of birth;
f. Primary language, if other than English, or
communication means and level;
g. Emergency contact;
h. Parent or next of kin;
i. Guardian, if applicable;
j. Home provider, if applicable;
k. Service coordinator; and
l. Health insurance, if any; and
(2) A current health assessment.
(e)
The service component of each individual’s record shall include at least
the following:
(1) A copy of the current service agreement
containing:
a. Goals and desired outcomes specific to the
individual’s participation in community participation services; and
b. The methods or strategies for achieving the
individual’s community participation services’ goals and desired outcomes;
(2) As a guide for planning activities, an
individual, week-long, personal schedule or calendar that is created at the
time of the annual service planning meeting and, if applicable, identifies:
a. The days, times, and locations of the
individual’s:
1. Paid employment;
2. Community activities, volunteerism, or
internship; and
3. Other regularly recurring activities, such as
therapeutic activities related to communication, mobility, and personal care;
and
b. The days and approximate times of unspecified
community activities, which shall not exceed 20% of the total community
participation service hours the individual receives per week;
(3) A record of daily community participation
services activities maintained by the provider agency, including:
a. The name(s) of individual(s) served and names
of staff supporting them;
b. The dates on which services were provided;
and
c. Activities that took place and the locations
of the activities;
(4) Narrative progress notes, and other service documentation
as specified in the service agreement, recorded at least monthly, and
addressing:
a. The individual’s community participation
services goals and actual outcomes; and
b. Other
activities related to the individual’s support services, health, interests,
achievements, and relationships;
(5) The individual’s medical status, including
current medications, known allergies, and other pertinent health care
information;
(6) Results of any screenings or evaluations that
have been conducted, including:
a. The Supports Intensity Scale (2004 edition),
available as noted in Appendix A;
b. Vocational assessments;
c. Results of any assistive technology
assessments;
d. The Health Risk Screening Tool (HRST) (2009
edition), available as noted in Appendix A;
e. START in-depth assessments and crisis plans;
and
f. Risk management plans; and
(7) For each individual for whom medications are
administered during community participation services, medication log
documentation pursuant to He-M 1201.07.
(f)
Records of service operations shall include the following:
(1) A register of current and prior individuals
who received community participation services, including termination dates when
applicable;
(2) A daily census;
(3) Documentation of all incident reports as
defined in He-M 202.02 (o);
(4) Evacuation drill records, if there is a
centralized service site; and
(5) Copies of emergency plans.
(g)
Provider agencies shall have personal injury liability insurance for the
staff and providers and for vehicles used to transport individuals. Proof of insurance shall be on file at the
provider agency premises.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED:
8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05, EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13; (from He-M 507.07)
He-M 507.09 Oversight and Quality Improvement.
(a)
The community participation services director shall:
(1) Be responsible for providing oversight; and
(2) Evaluate, facilitate, and improve the quality
of services being delivered and outcomes achieved.
(b)
Each individual’s service coordinator shall provide oversight regarding
the community participation service arrangement and review and facilitate the
effectiveness of the community participation services being provided and
outcomes achieved.
(c)
In fulfilling the responsibilities cited in (a) and (b) above, the
community participation services director and service coordinator shall
determine whether the following criteria are being met and, if not, take
appropriate action:
(1) Services are customized and meet the
interests, goals, and desired outcomes of the individual, as defined in the service
agreement;
(2) Goals reflect the individual’s growth and
evolving interests and are revised accordingly;
(3) The goals and desired outcomes identified in
the service agreement are being achieved;
(4) Staff are knowledgeable of the individual’s
service agreement as it pertains to community participation services and are
assisting in meeting the desired goals and outcomes;
(5) Services occur in integrated settings;
(6) Methods or strategies for achieving the
individual’s community participation services goals and desired outcomes are
evident and documented;
(7) An individual week-long personal schedule or
calendar is present; and
(8) Individuals, and guardians if applicable, are
satisfied with services.
Source. #4659, eff 8-4-89; EXPIRED: 8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff
4-16-05 (formerly He-M 507.08), EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.08)
He-M 507.10 Staff and Provider Qualifications.
(a)
Community participation services staff, contracted providers, and
consultants shall collectively possess professional backgrounds and
competencies such that the needs of the individuals who receive community
participation services can be met.
(b)
Community participation services shall be provided, in accordance with
each individual’s service agreement, by:
(1) Direct service staff;
(2) Contracted providers;
(3) Consultants;
(4) Professional staff;
(5) Non-professional staff; or
(6) Volunteers.
(c) All personnel identified in (b) above shall
be supervised by professional staff or by the director of community
participation services or his or her designee.
(d) If clinical consultants are
used, they shall be licensed or certified as required by New Hampshire law.
(e) All persons who provide community
participation services shall be at least 18 years of age.
(f) Prior to a person providing community
participation services to individuals, the provider agency, with the consent of
the person, shall:
(1) Obtain at least 2 references for the person;
(2) Complete, at a minimum, a New Hampshire
criminal records check;
(3) If a person’s primary residence is out of
state, complete a criminal records check for their state of residence;
(4) If a person has resided in New Hampshire for
less than one year, complete a criminal records check for their previous state
of residence; and
(5) Complete a motor vehicles record check to
ensure that the person has a valid driver’s license.
(g) Except as allowed in (h)-(i) below, the
provider agency shall not hire a person:
(1) Who has a:
a. Felony conviction; or
b. Any misdemeanor conviction involving:
1. Physical or sexual assault;
2. Violence;
3. Exploitation;
4. Child pornography;
5. Threatening or reckless conduct;
6. Theft;
7. Driving under the influence of drugs or
alcohol; or
8. Any other conduct that represents evidence of
behavior that could endanger the well being of an individual; or
(2) Whose name is on the registry of founded
reports of abuse, neglect, and exploitation pursuant to RSA 161-F:49.
(h)
A provider agency may hire a person with a criminal record listed in
(g)(1)a. or b. above for a single offense that occurred 10 or more years ago in
accordance with (i) and (j) below. In such
instances, the individual, his or her guardian, and the area agency shall review
the person’s history prior to approving the person’s employment.
(i)
Employment of a person pursuant to (h) above shall only occur if such
employment:
(1) Is approved by the individual, his or her
guardian and the area agency;
(2) Does not negatively impact the health or
safety of the individual(s); and
(3) Does not affect the quality of services to
individuals.
(j)
Upon hiring a person pursuant to (h) above, the provider agency shall
document and retain the following information in the individual’s record:
(1) Identification of the region, according to
He-M 505.04, in which the provider agency is located;
(2) The date(s) of the approvals in (h) above;
(3) The name of the individual or individuals for
whom the person will provide services;
(4) The name of the person hired;
(5) Description of the person’s criminal offense;
(6) The type of service the person is hired to
provide;
(7) The provider agency’s name and address;
(8) The certification number and expiration date
of the certified program, if applicable;
(9) A full explanation of why the provider agency
is hiring the person despite the person’s criminal record;
(10) Signature of
the individual(s) or legal guardian(s) indicating agreement with the employment
and date signed;
(11) Signature of the staff person who obtained
the individual’s or guardian’s signature and date signed;
(12) Signature of the area
agency’s executive director or designee approving the employment; and
(13) The signature and phone number of the person
being hired.
Source. #4659, eff 8-4-89; EXPIRED: 8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05 (formerly He-M 507.09),
EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13
He-M 507.11 Staff and Provider Training.
(a)
Prior to delivering community participation services to an individual,
the provider agency shall orient staff, contracted providers, and consultants
to the needs and interests of the specific individuals they serve, in the
following areas:
(1) Rights and safety;
(2) Health-related requirements including those
related to:
a. Current medical conditions, medical history,
and routine and emergency protocols; and
b. Any special nutrition, dietary, hydration,
elimination, or ambulation needs;
(3) Any communication needs;
(4) Any behavioral supports;
(5) The individuals’ service agreements,
including all goals and desired outcomes and methods or strategies to achieve
the goals and desired outcomes; and
(6) The community participation services’
evacuation procedures, if applicable.
(b)
Provider agencies shall:
(1) Assign staff to work with an experienced staff
member during their orientation if they have had no prior experience providing
services to individuals;
(2) Train staff in accordance with (c) below
within the first 6 months of employment; and
(3) Provide staff with training in accordance
with their annual individual staff development plans.
(c)
A provider agency shall train staff in the following areas within the first
6 months of employment:
(1) An overview of developmental disabilities and
acquired brain disorders, which shall include:
a. An overview of the different types of disabilities
and their causes;
b. An overview of the local and state service
delivery system; and
c. An overview of professional services and
technologies including therapies, assistive technologies, and environmental
modifications necessary to achieve individuals' goals in the community, in the
workplace, in recreation or leisure activities, and at home;
(2) An overview of conditions promoting or
detracting from the quality of life that individuals enjoy, which shall:
a. Aid staff to develop an understanding of the
stigmas, negative labels and common life experiences of people with disabilities;
and
b. Aid staff to gain the competencies necessary
to:
1. Support individuals to obtain and maintain
valued social roles;
2. Support individuals to build relationships
with their families, neighbors, co-workers and other community members;
3. Create and enhance opportunities for
individuals to:
(i) Increase their presence in the life of their
local communities; and
(ii) Increase the ways in which they contribute to
their communities;
4. Support individuals to have as much control
as possible over their own life;
5. Build individuals’ skills, strengths and
interests that are functional and meaningful in natural community environments;
and
6. Create conditions that provide opportunities
for individuals to experience and participate in a wide range of community
organizations and resources;
(3) Methods to assist individuals with
challenging behaviors utilizing positive behavioral supports;
(4) Techniques to:
a. Facilitate social relationships; and
b. Enhance skills that improve everyday living
and promote independence;
(5) Basic health and safety practices related to:
a. Personal wellness;
b. Success in living, working, and recreating in
the community; and
c. An understanding of the importance of common
signs and symptoms of illness; and
(6) Skills necessary to support individuals to:
a. Make their own decisions;
b. Advocate for themselves; and
c. Create their own social networks.
Source. #2269, eff 1-10-83; ss by #2963, eff 1-22-85;
ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED:
8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff
4-16-05 (formerly He-M 507.10), EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.09)
He-M 507.12 Prior Authorization of Community Participation
Services.
(a)
In order to receive community participation services, an individual
shall have a developmental disability or acquired brain disorder and a written
service agreement that includes one or more goals and desired outcomes for
community participation services.
(b)
An agency intending to provide community participation services to an
individual through the Medicaid program shall request prior authorization using
the procedure outlined in He-M 517.08 (b).
Source. #4659, eff 8-4-89; EXPIRED: 8-4-95
New. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05 (formerly He-M 50711),
EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13
He-M 507.13 Denial or Revocation of Certification.
(a)
The department shall deny an application for certification or issue a
notice of intent to revoke certification, following written notice pursuant to
(b) below and opportunity for a hearing pursuant to He-C 200, due to any of the
following reasons:
(1) Any reported abuse, neglect, or exploitation
of an individual by an applicant, provider, provider agency, or community
participation services staff, if:
a. Such abuse, neglect, or exploitation is
reported on the state registry of abuse, neglect, and exploitation in accordance
with RSA 161-F:49;
b. Such person(s) continues to have contact with
the individual; and
c. A waiver has not been received pursuant to
He-E 720.05;
(2) Except as provided in He-M 507.10(g)-(h), any
applicant, provider, provider agency, or community participation services staff
for whom He-M 507.10(f)(1) or (2) is true;
(3) A provider agency or area agency fails to
conduct criminal records check on all persons who are paid to provide services
under He-M 507;
(4) An applicant, provider, provider agency, or
community participation services staff has an illness or behavior that, as
evidenced by the documentation obtained or the observations made by the
department, would endanger the well-being of the individuals or impair the
ability of the provider agency to comply with department rules;
(5) An applicant or provider agency, or any
representative or employee thereof, knowingly provides materially false or misleading
information to the department;
(6) An applicant or provider agency, or any representative
or employee thereof, fails to permit or interferes with any inspection or
investigation by the department;
(7) An applicant or provider agency, or any
representative or employee thereof, fails to provide required documents to the
department;
(8) At an inspection the applicant or provider
agency is not in compliance with RSA 171-A or He-M 507 or other applicable
rules; or
(9) As a result of certification review, the
applicant or provider agency or certificate holder is not in compliance with
RSA 171-A or He-M 507 or other applicable rules and:
a. The applicant or provider agency failed to
fully implement and continue to comply with a plan of correction that has been
accepted by the department in accordance with He-M 507.06 (p); or
b. The applicant or provider agency has
submitted a revised plan of correction that has been rejected by the department
in accordance with He-M 507.06 (s).
(b)
Certification shall be denied or revoked upon the written notice by the
department to the applicant or provider agency stating the specific rule(s)
with which the provider agency does not comply.
(c)
Any applicant or provider agency aggrieved by the denial or revocation
of certification may request an adjudicative proceeding in accordance with He-M
507.15. The denial or revocation shall
not become final until the period for requesting an adjudicative proceeding has
expired or, if the applicant or provider agency requests an adjudicative
proceeding, until such time as the administrative appeals unit issues a decision
upholding the department’s action.
(d)
Pending compliance with all requirements for certification specified in
the written notice made pursuant to (b) above, a provider agency shall not
accept additional individuals if a notice of revocation has been issued
concerning a violation which presents potential danger to the health or safety
of the individuals being served.
(e)
If certification has been revoked, the provider agency shall transfer
all individuals to another appropriately certified community participation
service program within 10 days of certificate revocation becoming final in
accordance with (c) above
Source. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff 4-16-05, EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.11)
He-M 507.14 Immediate Suspension of Certification.
(a)
Notwithstanding the provision of He-M 507.13(c), in the event that a
violation poses an immediate and serious threat to the health or safety of an
individual, the department shall, in accordance with RSA 541-A:30, III, suspend
a provider agency’s certification immediately upon issuance of written notice
specifying the reasons for the action.
(b)
The department shall schedule and hold a hearing within 10 working days
of the suspension for the purpose of determining whether to revoke or reinstate
the provider agency’s certification. The
hearing shall provide opportunity for the provider agency whose certification
has been suspended to demonstrate that it has been, or is, in compliance with
the specified requirements.
Source. #6285, eff 7-12-96, EXPIRED: 7-12-04
New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05
New. #8324, eff
4-16-05 (formerly He-M 507.13), EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13;
ss by #10426, eff 10-1-13 (from He-M 507.12)
He-M 507.15 Appeals.
(a)
An applicant for certification, provider, provider agency, or area
agency may request a hearing regarding a proposed revocation or denial of
certification, except as provided in He‑M 507.14 above.
(b)
Appeals shall be submitted, in writing, to the bureau administrator in
care of the department’s office of client and legal services within 10 days
following the date of the notification of denial or revocation of certification.
(c)
The bureau administrator or his or her designee shall immediately
forward the appeal to the department’s administrative appeals unit which shall
assign a presiding officer to conduct a hearing or independent review, as
provided in He-C 200. The burden of
proof shall be as required in He-C 203.14.
Source. #8324, eff 4-16-05 (formerly He-M 507.14),
EXPIRED: 4-16-13
New. #10320, INTERIM, eff 4-25-13, EXPIRES:
10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.13)
He-M 507.16 Prior Authorization and Payment.
(a)
In order to receive Medicaid reimbursement for community participation services,
area agencies, as the enrolled providers of home and community‑based care
services, shall submit claims for payment to:
ACS Xerox
250 Commercial
Street, #1
Manchester, NH
03101
(b)
Payment for Medicaid waiver services shall only be made if prior
authorization has been obtained from the bureau pursuant to He-M 517.08.
(c) Requests for prior authorization shall be made
in writing to:
Division of
Community Based Care Services
Bureau of Developmental
Services
State Office Park
South
105 Pleasant
Street
Concord, NH 03301
Source. #10426, eff 10-1-13
He-M 507.17 Waivers.
(a) An applicant,
area agency, provider agency, individual, guardian, or provider may request a
waiver of specific procedures outlined in He-M 507 using the form titled “NH
bureau of developmental services waiver request” (September 2013
edition). The
area agency shall submit the request in writing to the bureau administrator.
(b) A completed waiver
request form shall be signed by:
(1) The individual or guardian indicating
agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c) A waiver request shall be submitted to:
Office of Client and Legal Services
Hugh J. Gallen State Office Park
105 Pleasant Street, Main Building
Concord, NH 03301
(d)
No provision or procedure prescribed by statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner or his or
her designee within 30 days if the alternative proposed by the requesting
entity meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not affect the quality of services to
individuals.
(f)
Upon receipt of approval of a waiver request, the requesting entity’s
subsequent compliance with the alternative provisions or procedures approved in
the waiver shall be considered compliance with the rule for which waiver was
sought.
(g)
Waivers shall be granted in writing for a specific duration not to
exceed 5 years except as in (h) and (j) below.
(h)
Those waivers which relate to other issues relative to the health,
safety or welfare of individuals that require periodic reassessment shall be
effective for the current certification period only.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
A requesting entity may request a renewal of a waiver from the
bureau. Such request shall be made at
least 90 days prior to the expiration of a current waiver.
Source. #10426, eff 10-1-13 (from He-M 507.15)
PART He-M 508 -
RESERVED
PART He-M 509 -
RESERVED
PART He-M 510 FAMILY-CENTERED EARLY SUPPORTS AND SERVICES
Statutory
Authority: RSA 171-A:18, IV; Part C of
Public Law 108-446, Individuals with Disabilities Education Improvement Act
(IDIEA) of 2004 (20 U.S.C. 1400 et seq.)
REVISION NOTE:
Document #5745, effective 12-1-93,
made extensive changes to the wording, format, structure, and numbering of
rules in Part He-M 510. Document #5745
supersedes all prior filings for the sections in this part. The prior filings for former Part 510 include
the following documents:
#2117, eff 8-1-82
#2663, eff 3-30-84
#2780, eff 7-24-84
EXPIRED 7-24-90
He-M
510.01 Purpose. In its role as designated lead
agency for the implementation of federally mandated Part C of Public Law
108-446 Individuals with Disabilities Education Improvement Act (IDEIA) of
2004, 20 U.S.C. 1400 et seq., the department establishes these minimum
standards for family-centered early supports and services
(FCESS). These services are provided in natural environments as part
of a comprehensive array of supports and services for families and their
children, as defined in He-M 510.02 (g), residing throughout New Hampshire.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; ss by #9135, INTERIM, eff
4-22-08, EXPIRED: 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13; ss by #13753, eff 9-27-23
He-M
510.02 Definitions. The words and phrases used in
these rules shall have the following meanings:
(a) “Applicant”
means any person under the age of 3 whose parent requests services pursuant to
He-M 510.06;
(b) “Area
agency” means “area agency” as defined in RSA 171-A:2, I-b, namely, “an entity
established as a nonprofit corporation in the state of New Hampshire which is
established by rules adopted by the commissioner to provide services to developmentally
disabled persons in the area in accordance with 42 CFR 441.301.”;
(c) “Assessment”
means the procedures used by personnel, as identified in He-M 510.11 (b)(1),
throughout the period of a child’s application and
eligibility under this part to identify the child’s unique strengths and needs
and the services appropriate to meet those needs, and includes:
(1) A
review of the multidisciplinary evaluation described in He-M 510.06
(k);
(2) Personal
observations of the child; and
(3) The
identification of the child’s needs in each of the following areas:
a. Physical development, including vision, hearing, or both;
b. Cognitive development;
c. Communication development;
d. Social
or emotional development; and
e. Adaptive
development;
(d) “Assistive technology
device” means any item, piece of equipment or product, whether acquired
commercially “off the shelf”, modified, or customized, that is used to
increase, maintain, or improve the functional capabilities of a
child. The term does not include medical devices that are surgically
implanted, or the optimization, such as mapping, maintenance, or replacement of
such devices.
(e) “At risk for substantial developmental delay”
means a child is a substance-exposed newborn, or experiences 3 or more of the following, as reported by the family and documented by
personnel listed in He-M 510.11 (b)(1):
(1) Documented
conditions, events, or circumstances affecting the child including:
a. Birth
weight less than 4 pounds;
b. Respiratory distress syndrome;
c. Gestational
age less than 27 weeks or more than 44 weeks;
d. Asphyxia;
e. Infection;
f. History
of abuse or neglect;
g. Prenatal
drug exposure due to mother’s substance abuse or withdrawal;
h. Prenatal
alcohol exposure due to mother’s substance abuse or withdrawal;
i. Nutritional problems that interfere with growth and development;
j. Intracranial hemorrhage grade III or IV; or
k. Homelessness; or
(2) Documented
conditions, events, or circumstances affecting a parent, including:
a. Developmental
disability;
b. Psychiatric
disorder;
c. Family
history of lack of stable housing;
d. Education less
than 10th grade;
e. Social
isolation;
f. Substance
misuse or abuse;
g. Age
of either parent less than 18 years;
h. Parent
and child interactional disturbances; or
i. Founded
child abuse or neglect as determined by a district court pursuant to RSA
169-C:21;
(f) “Atypical
behavior” means behavior reported by the family and documented by personnel listed
in He-M 510.11 (b)(1) that includes one or more of the following:
(1) Extreme
fearfulness or other modes of distress that do not respond to comforting by
caregivers;
(2) Self-injurious
or extremely aggressive behaviors;
(3) Extreme
apathy;
(4) Unusual
and persistent patterns of inconsolable crying, chronic sleep disturbances,
regressions in functioning, absence of pleasurable interest in adults and
peers, or inability to communicate emotional needs; or
(5) Persistent
failure to initiate or respond to most social situations;
(g) “Child” means an infant or toddler with a disability who is under
3 years of age and:
(1) Is
at risk for or has a developmental delay;
(2) Exhibits
atypical behavior; or
(3) Has
an established condition;
(h) “Commissioner”
means the commissioner of the New Hampshire department of health and
human services or their designee;
(i) “Consent” means that:
(1) The
parent has been fully informed, in the parent’s native language or other mode
of communication, of all information relevant to the activity for which
approval is sought;
(2) The
parent understands and agrees to, in writing, the carrying out of the activity
for which the parent’s approval is sought;
(3) The
written approval describes the approved activity and lists the records, if any,
that will be released and to whom; and
(4) The
parent understands that the granting of approval is voluntary on the part of
the parent, can be revoked at any time, and that revocation of approval is not
retroactive;
(j)
“Department” means the New Hampshire department of health
and human services;
(k) “Developmental delay” means that a child has a 33% delay in one or more
of the following areas as determined through completion of the
multidisciplinary evaluation pursuant to He-M 510.06 (k):
(1) Physical
development, including vision, hearing, or both;
(2) Cognitive
development;
(3) Communication
development;
(4) Social
or emotional development; or
(5) Adaptive
development;
(l) “Division for Children, Youth and Families (DCYF)” means the
organizational unit of the department of health and human services that
provides services to children and youth referred by courts pursuant to RSA
169-A, RSA 169-B, RSA 169-C, RSA 169-D, and RSA 463;
(m) “Early intervention specialist”
means an individual certified by the bureau in accordance with the criteria in
He-M 510.11 (k)-(m);
(n) “Established condition” means that a child has a diagnosed physical or
mental condition that has a high probability of resulting in a developmental
delay, even if no delay exists at the time of referral, as documented by the
family and personnel listed in He-M 510.11 (b)(1), including, at a minimum,
conditions such as:
(1) Chromosomal
anomaly or genetic disorder;
(2) Inborn errors of metabolism;
(3) A
congenital malformation;
(4) A
severe infectious disease;
(5) A
neurological disorder;
(6) A
sensory impairment;
(7) A
severe attachment disorder;
(8) Fetal
alcohol spectrum disorder;
(9) Lead
poisoning; or
(10) Toxic
exposure;
(o) “Family-centered
early supports and services (FCESS)” means a wide range of activities and
assistance, based on peer-reviewed research to the extent practicable, that develops
and maximizes the family’s and other caregivers’
ability to care for the child and to meet the child’s needs in a flexible
manner;
(q) “Family-centered
early supports and services (FCESS) program” means a program under contract
with the department to provide FCESS as defined in these rules;
(r) “Family
support council” means the regional council established pursuant
to RSA 126-G:4;
(s) “Foster
parent” means a person with whom a child lives and who is
licensed pursuant to He-C 6446 and certified pursuant to He-C 6347;
(t) “Frequency and intensity” means the number of days or sessions a service
will be provided and whether the service will
be provided on an individual or group basis;
(u) “Homeless children” means children under the age of 3 years who meet
the definition given the term “homeless children and youths” in section 725 (42
U.S.C. 11434a) of the McKinney-Vento Homeless Assistance Act, as amended, 42
U.S.C. 11431 et seq;
(v) “Individualized
family support plan (IFSP)” means a written plan developed in accordance with
He-M 510.07 for providing supports and services to an eligible child and family;
(w) “Informed clinical opinion” means the conclusion of a professional
identified pursuant to He-M 510.11 (b)(1) based on:
(1) Parent
observations of the child as reported to the professional;
(2) Parent
reports of the child’s developmental history;
(3) The
professional’s multiple and direct observations of the child at home or in
other community settings;
(4) The
professional’s review of pertinent records related to the child’s current
health status and medical history; and
(5) Formal
measures of the child’s activities and interactions with others;
(x) “Length” means the period of time the service is provided during
each session of that service;
(y) “Local
education agency (LEA)” means “local education agency” as defined in
Ed 1102.03 (n);
(z) “Medical home” means a model of delivering primary care that is
accessible, continuous, comprehensive, family-centered, coordinated,
compassionate, and culturally effective;
(aa) “Method”
means how a service is provided;
(ab) “Multidisciplinary” means the involvement of 2 or more individuals from
separate disciplines or professions;
(ac) “Native language” means:
(1) The
language normally used by the parent of the child in the home; or
(2) For
a child with deafness or blindness, or for a family with no written language,
the mode of communication normally used by the child and family such as sign
language, Braille, or oral communication;
(ad) “Natural
environment” means places and situations where the child’s age peers without
disabilities live, play, and grow;
(ae) “Natural supports” means people including but not limited to
family, relatives, friends, neighbors, childcare providers, clergy, and social groups
such as religious organizations, co-workers, and social clubs, available to
provide assistance as part of everyday living as well as during critical events;
(af)
“Notification” means referral of a child to the LEA and the NH
department of education;
(ag) “Parent” means:
(1) A
biological or adoptive parent of a child; or
(2) As
identified in a judicial decree or when the biological or adoptive parent does
not have legal authority to make educational or FCESS decisions on behalf of
the child:
a. A guardian
authorized to act as the child’s parent, or authorized to make early
intervention, educational, health, or developmental decisions for the child,
but not the state if the child is in the custody of the New Hampshire division
for children, youth, and families;
b. A
foster parent as defined in (s) above;
c. An individual
acting in the place of a biological or adoptive parent, including a
grandparent, stepparent, or other relative with whom the child lives;
d. A
surrogate parent as defined in (aq) below; or
e. Any other individual who is legally responsible for the
child’s welfare;
(ah) “Personally identifiable information” means:
(1) The
name of the parent(s);
(2) The
name of the child or other family members;
(3) The
address of the child;
(4) A
personal identifier such as the parent or child’s social security number; or
(5) A
list of personal characteristics, or other information that would make it
possible to identify the child or family with reasonable certainty;
(ai) “Potentially eligible” means that an estimation has been made by the
IFSP team, as described in He-M 510.07 (c), that a child might be eligible to
receive preschool special education services from the child’s LEA;
(aj) “Provider” means a person receiving any form of remuneration for the
provision of services to a child or family applying for or receiving FCESS
under He-M 510;
(ak) “Record” means, in accordance with the Family Educational Rights
and Privacy Act (FERPA) and 34 CFR 99.3, any information recorded in any way
including, but not limited to:
(1) Handwriting;
(2) Print;
(3) Computer
media;
(4) Video
or audio tape;
(5) Email;
(6) Text
message; and
(7) Any
other electronically stored information;
(al) “Region” means a geographic area designated pursuant to He-M
505.04 for the purpose of providing services to individuals with developmental
disabilities and their families;
(am) “Scientifically-based research” means “scientifically-based research” as
defined in the Elementary and Secondary Education Act (ESEA), Title IX, Part A,
section 9101(37) and 20 U.S.C. 7801(37);
(an) “Service coordinator” means a person who:
(1) Is
chosen or approved by the parent of the child;
(2) Is
identified in He-M 510.11(b);
(3) Together
with the family has the responsibility of planning, accessing, coordinating,
and monitoring the delivery of services for an eligible child’s and family; and
(4) Possesses
experience relevant to carrying out applicable responsibilities for the child
and family’s needs under He-M 510;
(ao) “Setting” means the
actual place(s) the services will be provided;
(ap) “Substance-exposed newborn” means
“substance-exposed newborn” as defined in RSA 171-A:18-a, namely, “a newborn who was exposed to alcohol, or other drugs in utero, which
may have adverse effects, whether or not this exposure is detected at birth
through a drug screen or withdrawal symptoms.”; and
(aq) “Surrogate parent” means a person who:
(1) Is
appointed by the lead agency;
(2) Is
trained by the lead agency regarding FCESS; and
(3) Acts
as a child’s advocate in the FCESS decision-making process, including the
transition to art B services, in place of the child’s:
a. Biological
parents;
b. Adoptive
parents; or
c. Guardian.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; amd by #7822, eff 2-8-03;
ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff 4-26-13;
ss by #13753, eff 9-27-23
He-M
510.03 Family-Centered Support and Service
Categories.
(a) Assistive
technology services shall directly assist a child in the selection,
acquisition, or use of an assistive technology
device, including:
(1) The
evaluation of the needs of a child, including a functional evaluation of the
child in the child’s customary environment;
(2) Purchasing,
leasing, or otherwise providing for the acquisition of assistive technology
devices by the family;
(3) Selecting,
designing, fitting, customizing, adapting, applying, maintaining, repairing, or
replacing assistive technology devices;
(4) Coordinating
and using other therapies, interventions, supports, or services with assistive
technology devices, such as those associated with existing IFSPs;
(5) Training
or technical assistance for a child or, if appropriate, that child’s family;
and
(6) Training
or technical assistance for professionals, including persons providing FCESS
and other persons who provide services to, or are otherwise substantially
involved in the major life functions of, children.
(b) Audiology services shall include:
(1) Identification
of children with auditory impairments, using at risk criteria and appropriate
audiologic screening techniques;
(2) Determination
of the range, nature, and degree of hearing loss and communication functions,
by use of audiological evaluation procedures;
(3) Referral
for medical and other services necessary for the habilitation or rehabilitation
of children with auditory impairment;
(4) Provision
of auditory training, aural rehabilitation, speech reading, and listening device
orientation and training, and other services;
(5) Provision
of services for prevention of hearing loss; and
(6) Determination
of the child’s need for individual amplification, including selecting, fitting,
and dispensing appropriate listening and vibrotactile devices, and evaluating
the effectiveness of those devices.
(c) Family
training, counseling, and home visits shall include assistance to the family in
understanding the special needs and building on the
interests of the child and enhancing the child’s development.
(d) Health services shall include services necessary to enable a
child to benefit from the other FCESS under He-M 510 during the time that the
child is eligible to receive other FCESS, including:
(1) Such
services as clean intermittent catheterization, tracheotomy care, tube feeding,
the changing of dressings or colostomy collection bags, and other health
services; and
(2) Consultation
by physicians with other FCESS providers concerning the special health care needs
of children that will need to be addressed in the course of providing other
FCESS.
(e) Health
services shall not include:
(1) Services
that are surgical in nature, such as cleft palate surgery, surgery for club
foot, or the shunting of hydrocephalus;
(2) Services
that are purely medical in nature, such as hospitalization for management of
congenital heart ailments or the prescribing of medicine or drugs for any
purpose;
(3) Services
related to the implementation, maintenance, replacement, or optimization, such
as mapping, of a medical device that is surgically implanted, including
cochlear implants;
(4) Devices
such as heart monitors, respirators and oxygen, and gastrointestinal feeding
tubes and pumps necessary to control or treat a medical condition; or
(5) Medical-health
services, such as immunizations and regular “well baby” care, that are routinely
recommended for all children.
(f) Nothing in He-M 510 shall:
(1) Limit
the right of a child who has a surgically implanted device, such as a cochlear
implant, to receive the early supports and services that are identified in the
child’s IFSP as necessary to meet the child’s developmental outcomes; or
(2) Prevent
the provider from routinely checking that either the hearing aid or the
external components of a surgically implanted device, such as a cochlear
implant, of a child are functioning properly.
(g) Medical services shall include services provided by a licensed
physician for diagnostic or evaluation purposes to determine a child’s
developmental status and need for FCESS.
(h) Nursing
services shall include:
(1) The
assessment of a child’s health status for the purpose of providing nursing
care, including the identification of patterns of human response to actual or
potential health problems;
(2) Provision
of nursing care to prevent health problems, restore or improve functioning, and
promote optimal health and development; and
(3) The
administration of medications, treatments, and regimens prescribed by a
licensed physician or an advanced practice registered nurse (APRN) in
accordance with RSA 326-B:11, III.
(i) Nutrition services shall include:
(1) Conducting
individual assessments in:
a. Nutritional
history and dietary intake;
b. Anthropometric,
biochemical, and clinical variables;
c. Feeding
skills and feeding problems; and
d. Food
habits and preferences;
(2) Developing
and monitoring appropriate plans to address the nutritional needs of children
based on the findings in (i)(1) above; and
(3) Making
referrals to appropriate community resources to carry out nutrition goals.
(j) Occupational therapy shall be services that:
(1) Address
the functional needs of a child related to adaptive development, adaptive
behavior and play, and sensory, motor, and postural development;
(2) Are
designed to improve the child’s functional ability to perform tasks in home,
school, and community settings; and
(3) Include:
a. Identification,
assessment, and provision of needed supports and services;
b. Adaptation
of the environment and selection, design, and fabrication of assistive and
orthotic devices to facilitate development and promote the acquisition of
functional skills; and
c. Prevention
or minimization of the impact of initial or future impairment, delay in
development, or loss of functional ability.
(k) Physical therapy shall be services that:
(1) Address
the promotion of sensorimotor function through enhancement of:
a. Musculoskeletal
status;
b. Neurobehavioral
organization;
c. Perceptual
and motor development;
d. Cardiopulmonary
status; and
e. Effective
environmental adaptation; and
(2) Include:
a. Screening,
evaluation, and assessment of children to identify movement dysfunction;
b. Obtaining,
interpreting, and integrating information to prevent, alleviate, or compensate
for movement dysfunction and related functional problems; and
c. Providing
individual and group services to prevent, alleviate, or compensate for movement dysfunction and related functional problems.
(l) Preventative
and diagnostic services shall be early and periodic screening, diagnosis, and
treatment services as specified in He-W 546.05 (a)
and (b).
(m) Psychological
services shall include:
(1) Administering
psychological and developmental tests and other assessment procedures;
(2) Interpreting
assessment results;
(3) Obtaining,
integrating, and interpreting information about child behavior and child and
family conditions related to learning, mental health, and development; and
(4) Planning
and managing a program of psychological services, including:
a. Psychological
counseling for children and parents;
b. Family
counseling;
c. Consultation
on child development;
d. Parent
training; and
e. Education
programs.
(n) Service coordination shall:
(1) Be
services provided by a service coordinator to assist and enable a child and the
child’s family to receive the services and rights, including procedural safeguards,
required under this part, He-M 203, and He-M 310;
(2) Be
an active, ongoing process that involves:
a. Assisting
parents of children in gaining access to, and coordinating the provision of,
the FCESS required under this part; and
b. Coordinating
the other services identified in the IFSP that are needed by, or are being
provided to, the child and that child’s family; and
(3) Include:
a. Coordinating
all services required under this part across agency lines;
b. Serving
as the single point of contact for carrying out the activities described in c.
– l. below;
c. Assisting
parents of children in obtaining access to needed supports and services and
other services identified in the IFSP, including making referrals to providers
for needed services and scheduling appointments for children and their
families;
d. Coordinating
the provision of FCESS and other services, such as educational, social, and
medical services that are not provided for diagnostic or evaluative purposes,
that the child needs or are being provided;
e. Coordinating
evaluations and assessments;
f. Facilitating and participating in the development, review, and
evaluation of IFSPs;
g. Conducting
referral and other activities to assist families in identifying available providers;
h. Coordinating,
facilitating, and monitoring the delivery of services required under this part
to ensure that the services are provided in a timely manner;
i. Conducting
follow-up activities to determine that appropriate services are being provided;
j. Informing
families of their rights and procedural safeguards, as set forth in He-M 203
and He-M 310, and related resources, including organizations with their
addresses and telephone numbers that might be available to provide legal
assistance and advocacy, such as the Disabilities Rights Center, Inc. and NH
Legal Assistance;
k. Coordinating
the funding sources for services required under this part; and
l. Facilitating
the development of a transition plan to preschool, school, or, if appropriate,
to other services.
(o) Use
of the term “service coordination” or “service coordination services” by an
FCESS program or provider shall not preclude characterization of the services
as case management or any other service that is covered by another payor of
last resort, such as Title XIX of the Social Security Act—Medicaid, for
purposes of claims in compliance with the requirements of 34 CFR 303.501 through 303.521.
(p) Sign
language and cued language services shall include:
(1) Teaching
sign language, cued language, and auditory and oral language;
(2) Providing
oral transliteration services, such as amplification; and
(3) Providing
sign and cued language interpretation.
(q) Social
work services shall include:
(1) Home
visits to evaluate a child’s living conditions and patterns of parent-child
interaction;
(2) Preparing
a social or emotional developmental assessment of the child within the family context;
(3) Providing
individual and family counseling with parents and other family members and
appropriate social skill building activities with the child and parents;
(4) Working
with the family to resolve problems in the family’s living situation, home, or
community that affect the child’s and family’s maximum utilization of FCESS;
and
(5) Identifying,
mobilizing, and coordinating community resources and services to enable the
child and family to receive maximum benefit from FCESS.
(r) Special instruction shall include:
(1) Designing
learning environments and activities that promote the child’s acquisition of
skills in a variety of developmental areas, including cognitive processes and
social interaction;
(2) Curriculum
planning, including the planned interaction of personnel, materials, and time
and space, that leads to achieving the outcomes in the IFSP;
(3) Providing
families with information, skills, and support related to enhancing the skill
development of the child; and
(4) Working
with the child to enhance the child’s development.
(s) Speech-language
pathology services shall include:
(1) Identification
of children with communicative or language disorders and delays in development
of communication skills, including the diagnosis and appraisal of specific
disorders and delays in those skills;
(2) Referral
for medical or other professional services necessary for the habilitation or
rehabilitation of children with communicative or language disorders and delays
in development of communication skills; and
(3) Provision
of services for the habilitation, rehabilitation, or prevention of communication
or language disorders and delays in development of communication skills.
(t) Transportation
services shall include reimbursing the family for the cost of travel such as
mileage, or travel by taxi, common carrier, or other means, and other related
costs such as tolls and parking expenses, that are necessary to enable an
eligible child and the child’s family to receive FCESS.
(u) Vision services shall include:
(1) Evaluation
and assessment of visual functioning, including the diagnosis and appraisal of
specific visual disorders, delays, and abilities that affect early childhood
development;
(2) Referral
for medical or other professional services necessary for the habilitation or
rehabilitation of visual functioning disorders, or both; and
(3) Communication
skills training, orientation and mobility training for all environments, visual
training, independent living skills training, and additional training necessary
to activate visual motor abilities.
(v) The
services and personnel identified and defined in (a)-(u) above shall not
comprise exhaustive lists of the types of services that may constitute FCESS or
the types of qualified personnel that may provide FCESS. Nothing in
this section shall prohibit the identification in the IFSP of another type of
service as an FCESS provided that the service meets the criteria in He-M 510.04.
(w) Children
and families who qualify for services under He-M 510 may have access to respite
services under He-M 513 and He-M 519 as well as other services authorized by
the department that meet the intent and purpose and are consistent with
evidence-based nationally recognized treatment standards.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; amd by #7822, eff 2-8-03;
ss by #9135, INTERIM, eff 4-22-08, EXPIRED: 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13; ss by #13753, eff 9-27-23
He-M
510.04 Provision of Supports and Services.
(a) FCESS shall:
(1) Be
selected in collaboration with parents and provided under public supervision by
personnel qualified pursuant to He-M 510.11;
(2) Be
provided under the system of payment described in He-M 510.14;
(3) Include
those of the services listed in He-M 510.03 (a)-(u), and other services
provided by personnel identified in He-M 510.11 (b), that meet the
developmental needs of the child and family and enhance the child’s
development;
(4) Comply
with state laws regulating the professional practice of persons providing
services, as well as the requirements of Part C of the IDEIA;
(5) To
the maximum extent appropriate, be provided in natural environments; and
(6) Be
provided in conformity with an IFSP.
(b) FCESS
shall be provided in a variety of natural environments where children and
families of the community gather, such as:
(1) The
family’s own home;
(2) Neighborhood
playgrounds;
(3) Child
care settings;
(4) Foster
placements;
(5) Relatives’
or friends’ homes;
(6) Libraries;
(7) Recreational
programs;
(8) Places
of worship;
(9) Grocery
stores;
(10) Shopping
malls; and
(11) Other
similar settings.
(c) FCESS shall incorporate the concerns, priorities, and resources
of the family to:
(1) Identify
and promote the use of natural supports as a principal way of assisting in the
development of the child, including supports from:
a. Relatives;
b. Fiends;
c. Neighbors;
d. Co-workers;
and
e. Cultural,
ethnic, or religious organizations;
(2) Foster
the family’s capacity to make decisions and provide care and learning opportunities
for their child;
(3) Respect
the cultural and ethnic beliefs and traditions, and the personal values and
lifestyle of the family;
(4) Respond
to the changing needs of the family and to critical transition points in the
family’s life; and
(5) Facilitate
access to community resources to support families and link them with other families
with similar concerns and interests.
(d) FCESS
shall include training, support, evaluation, special
instruction, and therapeutic services that maximize the family’s and other
caregivers’ ability to understand and care for the child’s developmental, functional,
medical, and behavioral needs at home as well as in settings described in (b)
above.
(e) FCESS
to the child and family and other caregivers shall be founded on
scientifically-based research to the extent practicable, and include assistance
in the following areas as identified in the family’s IFSP:
(1) Understanding
the child’s special needs;
(2) Support
and counseling for families;
(3) Management
and coordination of health and medical issues in collaboration with the primary
physician or medical home;
(4) Enhancement
of the cognitive, social interactive, and play competencies of the child at
home and in community settings;
(5) Enhancement
of the ability of the child to develop age-appropriate fine and gross motor skills
and overall sensory and physical awareness and development;
(6) Enhancement
of the ability of the child to develop functional communication methods and
expressive and receptive language skills;
(7) Guidance
and management of a child with very active, inappropriate, or life-threatening
behaviors;
(8) Consultation
regarding appropriate diet and the child’s eating and oral motor skills to
insure proper nutrition;
(9) Linkage
with assistive technology services that might enhance the child’s growth and
development; and
(10) Assessments
conducted throughout the period of the child’s eligibility.
(f) FCESS
shall promote local and statewide prevention efforts to reduce and, where
possible, eliminate the causes of disabling
conditions.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; ss by #9135, INTERIM, eff
4-22-08, EXPIRED: 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13; ss by #13753, eff 9-27-23
He-M
510.05 Parents’ Right to Written Prior Notice.
(a) FCESS programs shall give written notice to families before
proposing, refusing to initiate, or changing the eligibility for, evaluation
regarding, or provision of FCESS.
(b) The
written notice referenced in (a) above shall be provided, at a minimum, prior
to:
(1) Eligibility
evaluations;
(2) IFSP
development;
(3) IFSP
reviews;
(4) Changes
in IFSP services;
(5) The
transition planning conference; and
(6) Notification
pursuant to He-M 510.09 (f), (g), and (j).
(c) The written notice referenced in (a) above shall contain the
following information:
(1) The
proposed date and time of the action;
(2) The
action that is being proposed or refused;
(3) The
reasons for taking the action;
(4) All
procedural safeguards that are available under He-M 510, He-M 203, and He-M
310; and
(5) A
summary of the FCESS complaint resolution procedures set forth in He-M 203,
including a description of how to file a state administrative complaint and due
process complaint and the timelines under these procedures.
(d) The proposed date and time of the action in (c) above shall be
timely and convenient to the family.
(e) The notice shall be written in language that is understandable
to the general public and in the family’s native language or other mode of
communication used by the parent, unless it is clearly not feasible to do
so.
(f) If
the native language or the other mode of communication of the parent is not a
written language, the area agency or FCESS program
shall take steps to ensure:
(1) The
notice is translated orally, or by other means to the parent in the parent’s native
language, or other mode of communication;
(2) The
parent understands the notice; and
(3) There
is written evidence that the requirements of (1)-(2) above have been met.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; amd by #7822, eff 2-8-03;
ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13; ss by #13753, eff 9-27-23
He-M
510.06 Referral and Eligibility Determination.
(a) A
child as defined in He-M 510.02(g), who is a resident of New Hampshire shall
be eligible for FCESS.
(b) Any person may make a referral to FCESS.
(c) When a referral is made by someone other than the parent, the
FCESS program shall notify the parent immediately both verbally and in writing.
(d) Participation in FCESS shall be voluntary.
(e) The point of contact for referral to FCESS shall be the area
agency.
(f) An
area agency shall designate an intake coordinator to make initial contact with
families who are referred for FCESS.
(g) The
intake coordinator shall:
(1) Have
at least 2 years’ experience with children and their families;
(2) Demonstrate
the capacity to develop rapport with families;
(3) Have
knowledge of resources available in the community; and
(4) Act
as an interim service coordinator for families applying for FCESS until
eligibility is determined and a service coordinator identified.
(h) The
intake coordinator shall:
(1) Document
the date the referral was received;
(2) Provide
information relative to FCESS and other community services;
(3) Inform
the family of the process for the initiation of FCESS, including the family’s
rights under He-M 510 and He-M 310 and procedural safeguards under He-M 203;
(4) If
the family decides to seek a determination of eligibility for FCESS:
a. Obtain
parental consent for the initial evaluation and, if the applicant is eligible,
IFSP development;
b. Request
a release to obtain the applicant’s medical records and a physician’s referral
for evaluation;
c. Request
information about the applicant’s insurance, including public and private
insurance; and
d. Request
consent to utilize private insurance pursuant to He-M 510.14 (b)-(f); and
(5) If
the family decides not to seek a determination of eligibility for FCESS, make
reasonable efforts to ensure the parent:
a. Is
fully aware of the nature of the evaluation, the assessment, and the services
that would be available; and
b. Understands
that the applicant will not be able to receive the evaluation, the assessment,
or other services unless consent is given pursuant to
(4)a. above.
(i) If
a family decides to seek a determination of eligibility for FCESS,
the area agency shall conduct a multidisciplinary evaluation pursuant to (k) below
and a family directed assessment.
(j) The
purpose of the multidisciplinary evaluation shall be:
(1) To
determine if the applicant is eligible for FCESS according to (a) above and
He-M 510.02 (g); and
(2) To
provide information that will form the basis of the IFSP if the applicant is
eligible for FCESS.
(k) The
multidisciplinary evaluation shall:
(1) Be
based on informed clinical opinion;
(2) Be
conducted by an evaluation team composed of the family, other persons requested
by the family, and professionals from 2 or more different disciplines
identified in He-M 510.11 (b)(1);
(3) Be
conducted by professionals whose expertise most closely relates to the needs of
the applicant and family;
(4) Be
carried out in a setting that is convenient to the family;
(5) Include
the completion of the IDA Institute’s “Infant-Toddler Developmental Assessment-2
(IDA-2)”, (Second Edition) or Shine Early Learning’s “Hawaii Early Learning
Profile (HELP) Strands 0–3” (1992–2013), available as noted in Appendix A;
(6) Include
the components of the assessment as defined in He-M 510.02 (c);
(7) Include
the applicant’s medical and developmental history;
(8) Include
information from others sources such as family members, other caregivers,
medical providers, social workers, and educators, if necessary;
(9) Include
a review of the applicant’s medical, educational, or other records;
(10) Include
an evaluation of the applicant’s level of functioning in each of the following
developmental domains:
a. Physical
development, including vision, hearing, or both;
b. Cognitive
development;
c. Communication
development;
d. Social
or emotional development; and
e. Adaptive
development;
(11) Determined
through the use of an assessment tool and a voluntary family-directed personal
interview, include identification of:
a. The
family’s resources, priorities, and concerns; and
b. The supports
and services necessary to enhance the family’s capacity to meet the
developmental needs of the applicant;
(12) Be
conducted to:
a. Determine
an applicant’s eligibility or a child’s progress;
b. Define
or redefine services and expected outcomes; or
c. Plan
for future needs;
(13) Be
conducted in the applicant’s, child’s, or family’s native language if
determined by qualified personnel conducting the evaluation to be
developmentally appropriate, given the applicant’s or child’s age and
communication skills; and
(14) Be
selected and administered so as not to be racially or culturally discriminatory.
(l) An
applicant’s medical and other records may be used to establish eligibility
prior to conducting a multidisciplinary evaluation if those records contain
information regarding the applicant’s level of functioning in the developmental
areas identified in (k)(10) above.
(m) Based
on the results of the multidisciplinary evaluation pursuant to (k) above or
medical records in (l) above, the evaluation team
shall determine whether the applicant is a child as defined in He-M 510.02 (g) and
is eligible for FCESS pursuant to (a) above.
(n) If
the applicant is found eligible for FCESS, the area agency shall, in
writing, advise the family of its eligibility status within 3 business days and
include the name of, and contact information for, the service
coordinator.
(o) If
the applicant is found eligible based upon medical records in (l) above,
the area agency shall do an assessment of the child and a family assessment as
described in (k)(11) above.
(p) If
the applicant is found not eligible for FCESS, the area agency shall, in
writing, advise the family within 3 business days from date of eligibility
determination pursuant to He-M 510.05 of the following:
(1) The
findings of the evaluation and recommendations;
(2) Other
specific supports and services that meet the needs of the family, including
parent-to-parent networks, and an explanation of how to access those supports
and services;
(3) The
family’s right to file a complaint pursuant to He-M 203; and
(4) The
names, addresses, and telephone numbers of advocacy organizations, such as the
Disabilities Rights Center, Inc., that the family can contact for assistance in
challenging the determination.
(q) In
the event of exceptional family circumstances that make it impossible to
complete the initial evaluation and develop the IFSP
within 45 calendar days of the referral, the FCESS program shall:
(1) Document
the specific circumstances of the delay;
(2) Complete
the multidisciplinary evaluation as soon as family circumstances allow;
(3) Proceed
pursuant to (m)-(p) above; and
(4) Develop
and implement an interim IFSP, to the extent appropriate and consistent with
He-M 510.07 (a) and (g).
(r) Continued
eligibility shall be determined as noted in He-M 510.08 (e) and (f).
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; amd by #7822, eff 2-8-03;
amd by #8065, eff 3-25-04; ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09 (from He-M 510.05); ss by
#10325, eff 4-26-13; ss by #13753, eff 9-27-23
He-M 510.07 Initial and Annual IFSP
Development.
(a) With
parental consent, FCESS may begin prior to the completion of the
multidisciplinary evaluation if an interim IFSP is in place
that contains the name of the service provider responsible for the interim
services and a description of the services needed immediately and the elements
described in (h) below. Such an interim IFSP shall not preclude the
requirement in (b) below of completing the multidisciplinary evaluation and
developing a full IFSP within 45 calendar days from the initial date of the
referral.
(b) For
a child who has been evaluated for the first time and determined
to be eligible, a meeting to complete the initial IFSP shall be conducted within
45 calendar days from the initial date of referral received by the IFSP team,
described in (c) below.
(c) The
IFSP team shall be multidisciplinary and include the following participants:
(1) The
parent(s);
(2) The
service coordinator;
(3) The
person or persons directly involved in conducting the evaluation or assessment;
(4) Providers,
as appropriate; and
(5) As
requested by the parent:
a. Other
family members; and
b. An
advocate, or person outside the family.
(d) The
initial IFSP meeting shall be held at a time and place mutually agreed upon by
the IFSP team and convenient for the family.
(e) At
all IFSP team meetings, including reviews required pursuant to He- M 510.08(d),
if the person or persons identified in (c)(3) above is unable to attend, the FCESS program
shall make arrangements for their involvement through other means including:
(1) Participating
in telephone or virtual conference call;
(2) Having
a knowledgeable authorized representative attend the meeting; or
(3) Making
pertinent records available at the meeting.
(f) All
IFSP team meetings shall be conducted in the native language of the
family or other mode of communication used by the family, unless it is clearly not
feasible to do so.
(g) The
IFSP shall be based on the results of the multidisciplinary
evaluation.
(h) The
IFSP shall include:
(1) Information
about the child’s status in the domains noted in He-M 510.06 (k)(10);
(2) To
the extent the family agrees, a statement of the family’s concerns, priorities,
and resources related to enhancing the family’s capacity to meet the
developmental needs of the child;
(3) A
statement of the measurable results or measurable outcomes expected to be
achieved for the child and family, including pre-literacy and language skills
as developmentally appropriate for the child;
(4) The
criteria, procedures, and timelines used to determine the degree to which
progress toward achieving the outcomes is being made and whether modifications
or revisions of the expected results, outcomes, or services are necessary;
(5) A
detailed statement of the specific FCESS that are necessary to meet the unique
needs of the child and family to achieve the outcomes identified in the IFSP;
(6) The
length, frequency, intensity, anticipated duration, method of delivery,
location, and payment arrangement, if any, for each support and service;
(7) A
statement that each FCESS is provided in the natural environment for that child
to the maximum extent appropriate;
(8) Identification
of the natural environments in which the FCESS will be provided;
(9) A
justification of the extent, if any, as to why a support or service cannot be
provided in a natural environment, including:
a. An
explanation of why the supports or services cannot be provided satisfactorily
for the child in a natural environment;
b. A
plan of action that identifies how supports and services can be provided in a
natural environment in the future; and
c. A
time frame in which this plan will be implemented;
(10) A
summary of the documented medical services such as hospitalization, surgery,
medication, and other supports that the child needs or is receiving through
other sources but that are neither required nor funded under He-M 510;
(11) For
services described in (10) above that are not currently being provided, a
description of the steps the service coordinator or family can take to assist
the child and family in securing and funding those other services;
(12) The
name(s) and credentials of the person(s) responsible for implementing the
supports and services;
(13) The
earliest possible projected start date for each support and service as agreed
upon by the IFSP team, including the family;
(14) The
name, telephone number, agency, and location of the service coordinator;
(15) The
names of the members of the IFSP team participating in the development of the
plan;
(16) The
steps to be taken to support the transition described in He-M 510.09, including:
a. Discussions
with, and training of, parents, as appropriate, regarding future placements and
other matters related to the child’s transition;
b. Procedures to
prepare the child for changes in service delivery, including steps to help the
child adjust to, and function in, a new setting;
c. Confirmation
that child find system information, in accordance with 34 CFR 303.115, 303.302,
and 303.303, about the child has been transmitted to the LEA or other relevant
agency in accordance with He-M 510.09 (f) and (g); and
d. Identification
of transition services and other activities that the IFSP team determines are
necessary to support the transition of the child; and
(17) Services
to be provided to support the smooth transition of the child in accordance with
He-M 510.09 to:
a. Preschool
special education services to the extent that those services are appropriate;
or
b. Other
appropriate services.
(i) The
steps and services referred to in (h)(16)-(17) above shall be listed
in a document called a transition plan as described in He-M 510.09 (a).
(j) Through
discussion, all IFSP team members shall consider the advantages and
disadvantages of each FCESS suggested during the development of the IFSP.
(k) The
FCESS program shall explain the contents of the IFSP to the family prior
to the family consenting to the document.
(l) Parents
may elect to provide consent with respect to some FCESS and withhold
consent for others.
(m) Parents
may withdraw consent for some services without jeopardizing other
FCESS.
(n) The
IFSP shall be considered complete when the family has given consent by signing the
IFSP.
(o) The
following services shall be provided to each child at public expense at no cost
to the parent:
(1) Implementing
child find system requirements in accordance with 34 CFR Part 303.115, 303.302,
and 303.303;
(2) Evaluation
and assessment;
(3) Service
coordination;
(4) Development,
review, and evaluation of IFSPs; and
(5) Implementation
of procedural safeguards available under He-M 203 and Part C of Public Law
102-119, Individuals with Disabilities Education Act, 20 U.S.C. 1400 et seq.
(p) A meeting shall be conducted by the IFSP team,
described in (c) above, on at least an annual basis to evaluate and revise, as
appropriate, the IFSP for the child and the child’s family, according to the
following:
(1) The
annual IFSP meeting shall be held at a time and place mutually agreed upon by
the IFSP team and convenient for the family; and
(2) The
results of any current evaluations or current assessments of the child shall be
used in determining the early intervention services that are needed or
provided.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; amd by #7822, eff 2-8-03;
ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13; ss by #13753, eff 9-27-23
He-M 510.08 Implementation of the IFSP.
(a) FCESS shall be delivered as agreed upon in the IFSP.
(b) In
addition to arranging direct supports and services for the child
and parents or primary caregivers, the service coordinator shall link the child
and family with community resources identified in the IFSP.
(c) Each
IFSP shall be reviewed periodically at least once every 6 months, or more
frequently if a provider proposes adding or discontinuing a support or service
or if requested by the family.
(d) Such
a review shall:
(1) Include:
a. The
parent(s);
b. The
service coordinator;
c. If
requested, other family members, advocates, and persons outside the family; and
d. Other
members of the IFSP team as described in He-M 510.07 (c) and (e) if changes to
increase or reduce services in the IFSP are proposed;
(2) Be
arranged at a mutually agreed upon time and location; and
(3) Employ
a process that is convenient to the family.
(e) The
review pursuant to (c)-(d) above shall:
(1) Assess
progress toward achieving outcomes;
(2) Determine
if the FCESS in the IFSP continue to be appropriate;
(3) Determine
whether revisions or additions are needed to the IFSP; and
(4) Discuss continued eligibility for FCESS.
(f) At
the review, if the IFSP team is in disagreement regarding the child’s continued
eligibility, the FCESS program shall conduct a multidisciplinary evaluation following the
process described in He-M 510.06 (k).
(g) At
any time, the IFSP team, including the family, may request a multidisciplinary
evaluation or an assessment to determine progress review eligibility, redefine
services and outcomes, or plan for future needs.
(h) Before
implementation of any revision, deletion, or addition to the IFSP, the family
shall give consent and sign the revised
IFSP. If the family does not give consent, the IFSP shall remain
unchanged.
(i) If
the family has any concerns with the implementation of the IFSP, the family or
the service coordinator may request a
meeting. Such a meeting shall be held as soon as possible at a mutually
determined time and location that is convenient to the family and include the
family, the service coordinator, and others as requested who are involved in
providing supports and services to the family and child.
(j) If
the family’s concerns are not being addressed to the family’s satisfaction, the
procedural safeguards for FCESS identified in He-M
203 shall be made available.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; ss by #9135, INTERIM, eff
4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09 (from He-M 510.07); ss by
#10325, eff 4-26-13; ss by #13753, eff 9-27-23
He-M 510.09 Transition to Special Education Preschool
and Other Services.
(a) For
all children found eligible for FCESS prior to 33 months of age, the service
coordinator shall convene the IFSP team when the child is between 27 and 32
months to develop a transition plan for the child to exit the program that:
(1) Reviews
the child’s program options for the period from the child’s 3rd birthday
through the remainder of the school year;
(2) Identifies
steps for the child and the child’s family to exit the FCESS program;
(3) Identifies
any transition services needed by the child and family;
(4) Includes,
with parental consent, referrals to the area agency and other community
resources; and
(5) Determines
if the child is potentially eligible for preschool special education.
(b) If
the child is determined to not be potentially eligible for preschool special
education services, the service coordinator
shall convene a transition conference and make reasonable efforts to include
providers of other services to discuss appropriate services the child might
receive.
(c) If the child is determined to be potentially eligible for
preschool special education services, the service coordinator shall provide
parents information describing the notification requirement in (f) and (g)
below and their right to object, in (d) below, to information about their child
being provided to the responsible LEA and the NH department of education.
(d) If
a parent informs the FCESS program in writing within 7 calendar days of
receiving the information described in (c) above that they object to the
notification, the service coordinator shall not provide notification to the
responsible LEA and NH department of education.
(e) If
the parent objects to notification, the service coordinator shall convene a transition
conference and make reasonable efforts to include providers of other services
to discuss alternative ways of meeting the child’s needs.
(f) If
the parent does not inform the FCESS program within 7 calendar days, as
specified in (d) above, that they object, the FCESS program shall refer the child by notifying the responsible
LEA and NH department of education as soon as possible but not less than 90
calendar days before the child reaches their 3rd birthday that a child who is
potentially eligible for special education is receiving FCESS.
(g) Information provided with the notification and referral described in
(f) above shall include:
(1) The
child’s name;
(2) The
child’s date of birth;
(3) The
parents’ names;
(4) The
parents’ contact information including addresses and telephone numbers; and
(5) Additional
information with parental consent including a copy of the most recent
evaluation and assessments of the child and the most recent IFSP.
(h) After
the LEA and NH department of education have been notified that a child is
potentially eligible for services, the service coordinator
shall convene a transition conference that:
(1) Includes
the family, other persons requested by the family, the service coordinator, and
relevant providers;
(2) Is
conducted not less than 90 calendar days but not more than 9 months prior to
the child’s 3rd birthday; and
(3) Includes
the LEA representative.
(i) The
purpose of the transition conference shall be to:
(1) Review
the results of the IFSP team meeting held pursuant to (a) above;
(2) Update
the transition plan with input from the LEA representative and other providers;
and
(3) Discuss
the child’s program options for the period from the child’s 3rd birthday through
the remainder of the school year, if applicable, including any services the
child might be eligible to receive under Part B of IDEIA.
(j) For
a child who is determined eligible for FCESS more than 45 calendar days but
less than 90 calendar days before the child’s 3rd birthday, the FCESS program,
as soon as possible if the parent does not object, shall notify the LEA and NH department of education that the child will reach the
age for eligibility for Part B services.
(k) For
a child referred fewer than 45 calendar days before the child’s
3rd birthday, the FCESS program, following parental consent, shall refer the
child to the NH department of education and LEA as soon as
possible. The FCESS program shall not be required to conduct a
multidisciplinary evaluation or initial IFSP meeting.
(l) For
children exiting the program prior to 27 months of age or found no longer
eligible for FCESS, the service coordinator shall develop a transition plan
with the family that includes:
(1) Service
options for the family to explore based on future needs;
(2) Activities
as necessary to prepare the child for exiting the program;
(3) Information
about parent training and resources; and
(4) Referrals
to other community resources.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; ss by #9135, INTERIM, eff
4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13; ss by #13753, eff 9-27-23
He-M 510.10 Administration.
(a) Each
area agency shall develop an agreement with FCESS programs and the family support
council within the region to detail their mutual responsibilities in supporting
families who are participating in FCESS.
(b) The
agreement in (a) above shall:
(1) Describe
the process of referral, eligibility determination, and initiation of supports
and services in the area agency system;
(2) Provide
for streamlined mechanisms to enable families to easily access family support
services from the area agency pursuant to He-M 519;
(3) Provide
for ongoing contacts between staff of the area agency and the FCESS program to
ensure open communication and effective collaboration; and
(4) Provide
for procedures to address issues of common concern in the region.
(c) The
area agency shall develop a written agreement with the LEA that describes:
(1) Practices
that will enable FCESS and LEA personnel to collaborate effectively;
(2) When
and how information will be shared, including a statement of confidentiality;
(3) A
process to facilitate involvement of families, FCESS staff, and LEA staff in
transition conference planning activities and meetings; and
(4) Transition
activities that will take place such as home and program visits, observations,
and evaluations.
(d) Each
area agency, in cooperation with its family support council and FCESS programs,
shall document evidence of coordination with other local agencies that serve
children and their families, such as:
(1) The
regional offices of the New Hampshire division of public health
services;
(2) Local
education agencies;
(3) Visiting
nurse associations;
(4) Local
hospitals and medical clinics;
(5) Child
care providers;
(6) Family resource centers; and
(7) DCYF.
(e) Documentation
pursuant to (d) above shall include agreements, minutes of meetings, or
memoranda that demonstrate efforts to maximize the use of community resources
and prevent duplication of services for families.
(f) Each
area agency, in cooperation with the FCESS program, shall document evidence of outreach
to local agencies and providers serving children and their families to identify
children who might be eligible for FCESS.
(g) Area
agencies and FCESS programs shall comply with applicable state and federal
rules and regulations.
(h) FCESS
programs shall annually conduct and document quality assurance activities,
including, at a minimum:
(1) Constituent
surveys;
(2) Record
reviews;
(3) Performance
data measurements;
(4)
Participation in lead agency monitoring; and
(5) Development
and implementation of a corrective action plan if appropriate based on (1)-(4)
above.
(i) Area
agencies and FCESS programs shall enter the information identified below into
the lead agency’s statewide data system based on the following schedule:
(1) Immediately upon referral of a child, the following
information:
a. The child’s
name;
b. The child’s
date of birth;
c. The child’s
gender;
d. Date of
referral; and
e. Referral source;
(2) Once contact with the
family is established the following information shall be entered:
a. Parent
or guardian contact information;
b. The
child’s race and ethnicity;
c. Primary
language;
d. Date of intake;
e. Diagnosis
and reason for referral;
f. Insurance status, as one of the following types:
1. Public;
2. Private;
3. Both
public and private; or
4. None;
and
g. FCESS program name;
(3) Upon
eligibility determination:
a. Eligibility
status; and
b. Eligibility
category;
(4) Following
preparation of the IFSP:
a. The
date of parent or guardian consent;
b. IFSP
services to be provided;
c. The delivery method of the services to be
provided;
d. The frequency of the services to be provided;
e. The length, in minutes, of the services to be
provided;
f. The provider;
g. The environment, including a justification
statement if the environment is not a natural environment as defined in He-M 510.02(ad);
h. The projected start date of the services to
be provided;
i. Circumstances
regarding non-timely services;
j. Actual 6 month review date; and
k. Transition
plan activities;
(4) On
a monthly basis:
a. Updated
insurance status;
b. Services,
including evaluations, that have been provided; and
c. The
child’s updated diagnosis or eligibility status;
(5) Within
30 calendar days of the child exiting the program:
a. Child
outcome data required by 34 CFR 303.702; and
b. The
reason for exiting and date of exit; and
(6) As
they occur, notifications as required by He-M 510.09 (f), (g), and (k).
(j) Each
FCESS program shall have a designated program director who shall be responsible
for the overall administration of the supports and services and personnel
training and supervision. The director may be involved in the
provision of direct supports and services.
(k) FCESS
programs shall offer and provide a full array of FCESS to families throughout
the calendar year.
(l) FCESS
programs shall coordinate personnel schedules so that staff have opportunities
to share information and strategies across disciplines on a regular basis.
(m) The
area agency shall initiate a referral for a surrogate parent to the NH lead
agency in accordance with He-M 510.18 when:
(1) No
parent can be identified;
(2) A
child is under legal guardianship of the division for children, youth and
families; or
(3) A
court has issued a written order for a surrogate parent.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; ss by #9135, INTERIM, eff
4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13 (from He-M 510.11); ; ss by #13753, eff 9-27-23
He-M
510.11 Personnel.
(a) All
personnel shall have specific training and experience in child development and
knowledge of family support.
(b) Personnel
shall be drawn from the following categories:
(1) New
Hampshire licensed, department of education certified, or bureau of
developmental services certified professionals, including, at a minimum:
a. Advanced
practice registered nurse;
b. Audiologist;
c. Clinical
mental health counselor;
d. Clinical
social worker;
e. Dietitian
registered;
f. Early
childhood educator;
g. Early
childhood special educator;
h. Early
intervention specialist;
i. Marriage
and family therapist;
j. Occupational
therapist;
k. Orientation
and mobility specialist;
l. Pastoral
psychotherapist;
m. Physician;
n. Physician
assistant;
o. Psychologist;
p. Physical
therapist;
q. Registered
nurse;
r. Speech
language pathologist;
s. Speech-language
specialist;
t. Special
education teacher;
u. Special
education teacher in the area of blind and vision disabilities;
v. Special
education teacher in the area of deaf and hearing disabilities;
w. Special
education teacher in the area of emotional and behavioral disabilities;
x. Special
education teacher in the area of intellectual and developmental disabilities;
y. Special
education teacher in the area of physical and health disabilities;
z. Special
education teacher in area of specific learning disabilities; and
aa. Vision
specialist including ophthalmologists and optometrists;
(2) New
Hampshire licensed or certified professional assistants, including:
a. Licensed
physical therapy assistant;
b. Licensed
occupational therapy assistant; and
c. Certified
speech and language assistant; and
(3) Unlicensed
or uncertified personnel, including personnel who have education, training, or
experience relevant to the provision of FCESS.
(c) All
personnel shall utilize support strategies, assessment procedures, and
treatment techniques considered to be best practice in working with a child and
family applying for or receiving FCESS.
(d) All
personnel shall ensure the effective provision of FCESS, via a minimum of the
following:
(1) Consulting
with parents, other providers, and representatives of appropriate community
agencies;
(2) Participating
in the child’s multidisciplinary evaluation and the development of service
outcomes for the IFSP; and
(3) Coaching
parents and other persons chosen by the family regarding the provision of the
services.
(e) Personnel
identified in (b)(1) above shall:
(1) Conduct
multidisciplinary evaluations;
(2) Conduct
assessments;
(3) Develop
or amend IFSPs;
(4) Supervise,
when appropriate, licensed assistants and unlicensed personnel; and
(5) Provide
service coordination.
(f) Personnel
identified in (b)(2) above shall:
(1) Contribute
to the multidisciplinary evaluation;
(2) Contribute
to assessments;
(3) Contribute
to the development or amendment of IFSPs;
(4) Be
supervised, as required by their license or certification; and
(5) Provide
service coordination.
(g) Personnel
identified in (b)(3) above shall:
(1) Contribute
to the multidisciplinary evaluation;
(2) Contribute
to the assessment;
(3) Contribute
to the development or amendment of IFSPs;
(4) Be
supervised by one of the providers described in (b)(1) above at least once a
month in the setting where FCESS is provided, with additional supervision as
needed; and
(5) Provide
service coordination.
(h) All
FCESS personnel, including program directors and consultants, shall
meet New Hampshire requirements for certification, licensing, continuing
competence, or other comparable requirements.
(i) An
FCESS program director shall:
(1) Be
a licensed or certified professional pursuant to (b)(1) above;
(2) Have
3 years of professional experience providing FCESS; and
(3) Have
one year of professional experience in a management or administrative role.
(j) A
service coordinator shall:
(1) Have
completed the orientation program outlined in He-M 510.12 (b); and
(2) Together
with the family and other IFSP team member(s), be responsible for accessing,
coordinating, and monitoring the delivery of services identified in the child’s
IFSP, including transition services and coordination with other agencies and
persons.
(k) An
individual who wishes to obtain certification as an early intervention
specialist shall submit information to the bureau documenting:
(1) Possession
of a minimum, in addition to the requirements in (2) below, of a bachelor’s
degree in:
a. Human
services;
b. Family
studies;
c. Psychology;
d. Child
development;
e. Communication;
f. Child
life;
g. Education;
h. Behavior
analysis; or
i. Early
intervention;
(2) A
minimum of one year experience in an FCESS program for degrees listed in (1) a.
- h. above;
(3) A
minimum of 6 months’ experience in an FCESS program for the degree listed in
(1) i. above;
(4) Possession
of a minimum, in addition to the requirements in (5) below, of an associate’s degree
or minor of studies in:
a. Physical
therapy assistant;
b. Occupational
therapy assistant;
c. Speech
and language assistant;
d. Child
development;
e. Child
life;
f. Education;
or
g. Early
intervention;
(5)
A minimum of 2 years’ experience in an FCESS program for degrees listed in (4)
a. - g. above;
(6) Completion
of the orientation program outlined in He-M 510.12 (b); and
(7) Training and experience in the subject matter
in (e)(1)-(3) and (5) above.
(l) Upon
completion of (k) above, the bureau shall certify the individual as an early
intervention specialist.
(m) To
continue to be certified as an early intervention specialist, individuals
identified in (k) above shall demonstrate ongoing professional development as
described in He-M 510.12 (e).
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; ss by #9135, INTERIM, eff
4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09 (from He-M 510.08); ss by
#10325,e ff 4-26-13; ss by #10325, eff 4-26-13 (from He-M 510.12); ss by
#13753, eff 9-27-23
He-M
510.12 Personnel Development.
(a) All
new personnel who provide service coordination or work directly with families, including
personnel involved with intake activities, shall participate in an orientation
program pursuant to (b) below within 6 months from the date of hire.
(b) The
lead agency orientation program shall consist of training and include
information about:
(1) The
history and philosophy of FCESS;
(2) Provision
of service coordination;
(3) Eligibility
evaluation and ongoing assessment;
(4) Procedural
safeguards pursuant to He-M 203;
(5) Scientifically
based research practices in FCESS evaluations, provision of supports, and
service delivery;
(6) Funding
for FCESS;
(7) IFSP
development and implementation; and
(8) Transition
from FCESS to community services such as special education.
(c) Each
employee involved in the provision of FCESS to families shall have an annual
personnel development plan approved by the FCESS program
director. The purpose of the personnel development plan shall be to
sustain and improve the relevant skills and knowledge of the employees such
that the requirements of He-M 510.11 (d) and (h) have been
met. Successful achievement of professional development goals shall
be included in the criteria for annual review of performance.
(d) Personnel
development plans for FCESS program directors shall be developed with, and
monitored by, the director’s supervisor.
(e) As
a part of their annual personnel development plan an early intervention
specialist shall acquire at least 24 hours of continuing education credit in
subject matter relevant to their job description, as determined by the program
director.
(f) The area agency shall provide all program
staff who work directly with families, annual training in procedural safeguards
pursuant to He-M 203.
(g) The lead agency shall provide training
on child outcome summary and outcome development to all program staff who directly
work with families within 6 months of hire.
(h) The lead agency shall provide
training on ensuring culturally competent services and adult learning
strategies to all program staff who directly
work with families within one year of hire.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; amd by #7822, eff 2-8-03;
ss by #9135, INTERIM, eff 4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09 (from He-M 510.09); ss by
#10325, eff 4-26-13 (from He-M 510.13); ss by #13753, eff 9-27-23
He-M
510.13 Record keeping.
(a) Each
program shall maintain individual family records that contain, at a minimum,
the following:
(1) Personal
information that shall include:
a. Identifying
information including:
1.
The child’s name, family name(s), address(es), telephone number(s), and email(s);
and
2. The
child’s birth date;
b. The
name of the service coordinator;
c. The
name, address, and telephone number of the child’s primary health care
provider; and
d. Health
insurance information;
(2) Medical
information that shall include:
a. A
record of a physical examination conducted within the past year;
b. Documentation
by qualified medical personnel of any established condition(s), as identified
in He-M 510.02 (n), including diagnosis;
c. A
record of immunizations;
d. A
list of any required prescriptions; and
e. Other
pertinent medical records;
(3) The
current multidisciplinary evaluation of the child and family pursuant to He-M
510.06 (k);
(4) The
current IFSP signed by the parent;
(5) Written
documentation of each contact with the child and family by the provider,
including:
a. A
description of the service provided;
b. A
description of the child’s and family’s response;
c. The
date, location, and duration of the contact; and
d. The
name and credentials of the provider;
(6) Reviews
of progress once every 6 months or more frequently;
(7) Copies
of any letters or notifications written to, or on behalf of, the family;
(8) Information
obtained from other agencies or programs that the family believes is important
in developing or providing FCESS; and
(9) Releases
of information providing consent obtained from the family for evaluation and
for the exchange of information among agencies and providers.
(b) Each
FCESS program shall have a standard release or exchange of information form,
compliant with all state and federal laws, which shall be valid for no longer
than one year.
(c) All
release or exchange of information forms shall include:
(1) The
child’s name and birth date;
(2) The
information to be released or obtained;
(3) The
purpose of obtaining or releasing the information;
(4) The
name of the person or organization being authorized to release the information;
(5) The
name of the person or organization to whom the information is to be released;
and
(6) The
time period for which the authorization is given, if less than one year.
(d) Each
FCESS program shall maintain a log of access and disclosures of information
that includes:
(1) The
information accessed or disclosed;
(2) The
date of access or disclosure;
(3) The
name of the recipient of the information; and
(4)
The purpose for which the party is authorized to use the FCESS records.
(e) Each
provider and FCESS program shall maintain the confidentiality of a child’s and
family’s records and protect the child’s and family’s personally identifiable
information at the collection, storage, disclosure, and destruction stages in
accordance with FERPA.
(f) Each
FCESS program shall designate a staff member responsible for ensuring the
confidentiality of any personally identifiable information, in compliance with
federal law.
(g) Each
FCESS program shall have policies for the training of all personnel in the
collection or use of personally identifiable information and compliance with
IDIEA and FERPA.
(h) Parents
shall have the following rights with regard to FCESS records for their
children:
(1) The
right to inspect and review FCESS records at any time;
(2) The
right to make requests for explanations and interpretations of the records and
to receive a response to these requests within 3 business days;
(3) The
right to receive, upon request, copies of records in accordance with (k) and (l)
below; and
(4) The
right to have a representative of the parent inspect, review, and receive
copies of the records.
(i) FCESS
programs shall give each family a list of the types and locations of records
collected, maintained, or used by FCESS personnel. All parents shall
have the right to access such records unless a particular parent does not have
this authority under state law.
(j) Information
shall be made available only:
(1) To
those persons or agencies for whom the parent or guardian has given written
consent;
(2) To
FCESS personnel;
(3) To
the department or other funding, licensing, or accrediting agencies as
necessary for determining eligibility for funding or for assisting in
accrediting, monitoring, or evaluating supports and services delivery; or
(4) As
otherwise required by law.
(k) Each
FCESS program shall make copies of records available to parents free of charge
for the first 25 pages and not more than 10 cents per page
thereafter. The fee shall not effectively prevent the parents from
exercising their right to inspect and review those records. A fee
shall not be charged for searching for or retrieving information.
(l) Copies
of the following documents shall be provided at no cost to the family as soon
as possible after each IFSP meeting:
(1) Evaluations;
(2) Assessments
of the child and family; and
(3) The
IFSP.
(m) FCESS
programs shall advise families of their right to request that records be
corrected or amended if they believe the information collected, maintained, or
used is inaccurate or misleading or violates the privacy or other rights of the
child or family.
(n) The
FCESS program shall take steps to accommodate any request pursuant to (m)
above.
(o) If
the FCESS program refuses to amend the information as requested, the program
director shall inform the parent of the refusal, why the request to amend the
information was refused, and advise the parent of the right to complain
pursuant to He-M 203.
(p) If,
as a result of a complaint resolution it
is decided, pursuant to He-M 203, that the information contained in the records
is inaccurate, misleading, or otherwise in violation of privacy or other rights
of the child, the FCESS program shall amend the information accordingly and so
inform the parent(s) in writing.
(q) If,
as a result of a complaint resolution it is decided, pursuant to He-M 203, that
the information contained in the records is not inaccurate, misleading, or otherwise
in violation of privacy or other rights of the child, the FCESS program shall
inform the parent(s) of the right to place in the records a statement
commenting on the information or setting forth any reasons for disagreeing with
the decision of the FCESS program.
(r) Any
explanation placed in the records of the child shall be maintained by the FCESS
program as part of the records of the child as long as the record, or the
contested portion of a record, is maintained by the program.
(s) If
the record, or the contested portion of a record, is disclosed by the FCESS
program to any party, the explanation shall be disclosed to the party.
(t) The
FCESS program shall inform the parent(s) when personally identifiable
information collected, maintained, or used is no longer needed to provide
supports and services to the child.
(u) Personally
identifiable information that is no longer needed by an FCESS program shall be
destroyed at the request of the parent(s).
(v) Notwithstanding
(u) above, a permanent record of the following shall be maintained without a
time limitation:
(1) The
child’s name and date of birth;
(2) The
parents’ contact information including address and telephone number;
(3) The
name of the service coordinator(s) and early supports and services provider(s);
and
(4) Exit
data including the year and child’s age and any programs entered into upon
exiting.
(w) Records
that parents have not requested to be destroyed shall be retained for at least
6 years following termination of service.
(x) All
evaluations and assessments, notices of eligibility for services, IFSPs,
notices of meetings, information regarding procedural safeguards, progress
reports, and consent forms shall be written in language understandable to the
general public and provided to the family in their native language or primary
mode of communication unless it is unfeasible to do so. If the family’s
native language or means of communication is not a written language, the FCESS
program shall take steps to ensure that the information is translated orally or
by the mode of communication the family typically uses so that the information
is meaningful and useful.
Source. (See Revision Note at part heading for He-M
510) #5745, eff 12-1-93, EXPIRED: 12-1-99
New. #7234, eff 4-22-00; ss by #9135, INTERIM, eff
4-22-08, EXPIRED 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff 4-26-13
(from He-M 510.14); ss by #13753, eff 9-27-23
He-M
510.14 Utilization of Public and Private Insurance.
(a) When
a child is covered by private insurance or enrolled in Medicaid, the FCESS
program shall use these benefits to pay for FCESS in accordance with (b) – (k)
below.
(b) The
FCESS program shall not use the private insurance of a parent or child to pay
for FCESS unless the parent provides parental consent. This includes the
use of private insurance when such use is a prerequisite for the use of
Medicaid.
(c) When
an FCESS program uses a child’s private insurance, the program shall not
collect costs associated with the use of private insurance from the child’s
family, including the cost of deductibles, coinsurance and co-pays.
(d) When
private insurance is used to pay for FCESS, the FCESS program shall obtain
parental consent at the following times:
(1) When
an FCESS program seeks to use the child’s private insurance to pay for the
initial provision of an FCESS identified in the IFSP; and
(2) Each
time there is an increase in the provision of services and a related change in
the child’s IFSP.
(e) When
obtaining consent under (d) above or initially using benefits under a private
insurance policy, an FCESS program shall provide to the child’s parents:
(1) A
copy of the system of payments described in He-M 510.14; and
(2) Notice
of the potential costs to the parent when private insurance is used to pay for
early intervention services, including premiums or other long-term costs
associated with annual or lifetime health insurance coverage caps.
(f) An
FCESS program shall not delay or deny the provision of any services in the IFSP
when a parent does not provide consent to use private insurance.
(g)
If a parent does not provide consent to use private insurance, an FCESS
program shall utilize funds available in contract with the department, including
federal funds available pursuant to 34 CFR 303.510(a), for the provision of any
services in the IFSP.
(h)
If funds are utilized pursuant to (g) above, the parent shall not be
required to reimburse any such funds.
(i) When
Medicaid benefits are used to pay for FCESS, the FCESS program shall provide
written notice to the child’s parents that includes:
(1) A
statement of the no-cost protection provisions in 34 C.F.R. §303.520(a)(2);
(2) Pursuant
to (k) below, a statement that a parent’s refusal to enroll in Medicaid shall
not delay or cause to be denied the provision of any services in the child’s
IFSP; and
(3) A
description of the general categories of costs that the parent would incur as a
result of participating in Medicaid, including the required use of private
insurance as the primary insurance.
(j) An
FCESS program shall not require a parent to sign up for or enroll in Medicaid
as a condition of receiving FCESS.
(k) An
FCESS program shall not delay or deny the provision of any services in the
child’s IFSP if a parent does not enroll in Medicaid.
(l) The
FCESS program shall maintain up to date insurance
coverage information for each child.
Source. #9594, eff 11-11-09 (from He-M 510.11); ss by
#10325, eff 4-26-13 (from He-M 510.15); ss by #13753,
eff 9-27-23
He-M 510.15 Interagency Coordinating
Council. The purpose of the interagency coordinating council
shall be to provide advice to the lead agency regarding the FCESS
program. The interagency coordinating council shall be established
and operated pursuant to 34 CFR Part 303, Subpart G.
Source. #9594, eff 11-11-09; ss by #10325, eff
4-26-13 (from He-M 510.16); ss by #13753, eff 9-27-23
He-M
510.16 Central Directory.
(a) The purpose of the
central directory shall be to provide information about:
(1) Public
and private early
intervention services, resources, and experts
available in the state including professionals and other groups that provide
assistance to children; and
(2) Research
and demonstration projects related to children.
(b) The central directory
shall be maintained and operated pursuant to 34 CFR Part 303.117.
Source. #9594, eff 11-11-09; ss by #10325, eff
4-26-13 (from He-M 510.17); ss by #13753, eff 9-27-23
He-M
510.17 Waivers.
(a) An area agency, FCESS
program, parent, or provider may request a waiver of specific procedures
outlined in He-M 510.
(b) The
entity requesting a waiver shall:
(1) Complete
the form entitled “NH Bureau of Developmental Services Waiver Request” (July
2019 edition); and
(2) Include
a signature from the parent(s) or legal guardian(s) indicating agreement with
the request and the area agency’s executive director or designee recommending
approval of the waiver.
(c) No
provision or procedure prescribed by statute or federal regulation shall be
waived.
(d) The
request for a waiver shall be granted by the commissioner or the commissioner’s
designee within 30 calendar days if the alternative proposed by the requesting
entity meets the objective or intent of the rule and it:
(1) Does
not negatively impact the health or safety of the child; and
(2) Does
not affect the quality of services to the child.
(e) The
determination on the request for a waiver shall be made within 30 calendar days
of the receipt of the request.
(f) Upon
receipt of approval of a waiver request, the requesting entity’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(g) Waivers
shall be granted in writing for a specific duration not to exceed 5 years
except as in (i) below.
(h) Any
waiver shall end with the closure of the related program or service.
(i) The
requesting entity may request a renewal of a waiver from the
department. Such request shall be made at least 90 calendar days
prior to the expiration of a current waiver.
Source. #9594, eff 11-11-09; ss by #10325, eff
4-26-13 (from He-M 510.18); ss by #13753, eff 9-27-23
He-M 510.18 Surrogate Parent.
(a) A surrogate
parent shall be appointed by the lead agency in the following circumstances:
(1) No parent
as defined in He-M 510.02(ag) can be identified;
(2) The lead agency, area agency, or
FCESS program, after reasonable efforts, including, but not limited to telephone calls and e-mails with documentation of
the dates and times of the attempts, cannot locate a parent;
(3) The
child is in the custody of DCYF and the court overseeing the case has not
appointed a surrogate parent meeting the requirements of (f) below; or
(4) When a court has issued a written order for a
surrogate parent.
(b) An application for appointment of
a surrogate parent shall be submitted to the
lead agency by an area agency or FCESS program if any of the criteria in (a) above are present.
(c) Within 30 days of
the receipt of a completed application pursuant to (b) above, the lead agency
shall determine whether the child needs a surrogate parent, and if necessary, assign
a surrogate parent.
(d) In order to determine whether a child needs a
surrogate parent, the lead agency shall obtain information that demonstrates one of the following:
(1) A parent cannot be
identified because there is no written record of the existence of such a person
available to the area agency, FCESS program, or lead agency;
(2) A parent is not able to be located by the FCESS program or area agency as
evidenced through documentation of efforts including but not limited to,
telephone calls and emails and the date, time of attempts to contact parent.
(3) The FCESS program or area agency has contacted DCYF for assistance; or
(4) The absence of a court order
appointing a surrogate parent for a child in the custody of DCYF.
(e) For children in the custody of DCYF, the lead agency must collaborate with DCYF to
obtain necessary information for the appointment of a surrogate parent.
(f) The lead
agency shall select individuals to be available to serve as surrogate parents
provided such individuals:
(1) Have volunteered to serve as a
surrogate parent;
(2) Have satisfactorily completed training to serve as a surrogate parent provided by the lead
agency or designee;
(3) Are 21 years of age or over;
(4) Have agreed in writing to serve
as a surrogate parent from the date of appointment;
(5) Have no interest that conflicts personally or
professionally with the interest of the child they represents;
(6) Are not employees of the lead agency, area agency, or
FCESS program responsible for the services, education, care, or any other services to the child or any family member of the
child, or the school district of liability related to the transition process;
and
(7) Have provided consent to a
check of state registries of founded reports of abuse, neglect, exploitation, as established by RSA 161-F:49 and RSA 169-C:35, and their names do not
appear on said registries.
(g) A surrogate parent assigned by the lead agency shall
have the same rights and responsibilities as a parent defined in He-M 510.02(ag)
for purposes of this chapter.
(h) The lead agency shall terminate the appointment of a surrogate parent when:
(1) A parent becomes known, is located, or rescinds their request or consent to have a
surrogate parent appointed and will assume educational decision-making;
(2) The child ceases to be under
legal custody of DCYF or guardianship of DCYF per RSA 463;
(3) The child is placed within a relative foster
placement;
(4) The child is
adopted; or
(5) When the assigned surrogate parent provides 30 days’ notice to the lead agency of the
desire to end the surrogate parent relationship.
Source. #13753, eff 9-27-23
PART He-M 511 - RESERVED
REVISION NOTE:
Document #5048, effective 1-18-91,
made extensive changes to the wording, format, structure, and numbering of
rules in Part He-M 511. Document #5048
supersedes all prior filings for the sections in this part. The prior filings for former Part He-M 511
include the following documents:
#2032, eff 6-7-82
#2680, eff 4-18-84
EXPIRED 4-18-90
Source. (See Revision Note at part heading for He-M
511) #5048, eff 1-18-91, EXPIRED: 1-18-97
PART He-M 512 -
RESERVED
PART He-M 513 RESPITE SERVICES
Statutory
Authority: New Hampshire RSA 171-A:3;
171-A:18, IV
REVISION NOTE:
Document #4495, effective 9-23-88,
made extensive changes to the wording, format, structure, and numbering of
rules in Part He-M 513. Document #4495
supersedes all prior filings for the sections in this part. The prior filings for former Part He-M 513
include the following documents:
#2747, eff 6-14-84 EXPIRED 6-14-90
He-M 513.01 Purpose. The purpose of these rules is to establish
standards for respite services as part of a system of community based services
and supports responsive to the changing needs of individuals with developmental
disabilities or acquired brain disorders
and their families. These rules also
apply to children, birth through age 2, and their families who are eligible for
family-centered early supports and
services.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New.
#6155, eff 12-29-95; ss by #8016, eff 12-29-03; ss by #10030, eff
12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED:
6-17-20
New. #13263, eff 9-22-21
He-M 513.02 Definitions.
(a) “Acquired brain disorder” means a disruption
in brain functioning that:
(1) Is not congenital or caused by birth trauma;
(2) Presents a severe and life-long disabling condition
which significantly impairs a person’s ability to function in society;
(3) Occurs prior to age 60;
(4) Is attributable to one or more of the
following reasons:
a. External trauma to the brain as a result of:
1. A motor vehicle incident;
2. A fall;
3. An assault; or
4. Another related traumatic incident or
occurrence;
b. Anoxic or hypoxic injury to the brain such as
from:
1. Cardiopulmonary arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases such as encephalitis and
meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; or
h. Other neurologic disorders, such as Huntington’s
disease or multiple sclerosis, which predominantly affect the central nervous
system; and
(5) Is manifested by one of the following:
a. Significant decline in cognitive functioning
and ability; or
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits.
(b)
“Area agency” means “area agency” as defined in RSA 171-A:2,I-b.
(c)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(d) “Bureau administrator” means the chief
administrator of the bureau of developmental services.
(e)
“Developmental disability” means “developmental disability” as defined
in RSA 171‑A:2, V, namely "a disability:
(1) Which is attributable to an intellectual
disability, cerebral palsy, epilepsy, autism, or a specific learning
disability, or any other condition of an individual found to be closely related
to intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability; and
(2) Which originates before such individual attains
age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual's ability to function
normally in society."
(f)
“Family” means a group of 2 or more persons that:
(1) Is related by marriage, ancestry, or other
legal arrangement;
(2) Is living in the same household; and
(3) Has at least one member who is an individual
as defined in (h) below.
(g)
“Home and community‑based care waiver (HCBC-DD)” means that waiver
of sections 1902(a)(10) and 1915(c) of the Social Security Act which allows the
federal funding of long‑term care services in non-institutional settings
for persons who are elderly, disabled, or chronically ill.
(h)
“Individual” means a person with a developmental disability or acquired
brain disorder or a child, birth through age 2, who is eligible for family-centered
early supports and services pursuant to He-M 510.06(a).
(i)
“Respite service provider” means a person or agency that delivers
respite services to an individual and his or her family who are eligible for
area agency services and supports.
(j)
“Respite services” means the provision of short‑term care for an individual,
in or out of the individual's home, for the temporary relief and support of the
family with whom the individual lives.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New. #6155, eff 12-29-95; ss by #8016, eff
12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED:
6-17-20
New. #13263, eff
9-22-21
He-M 513.03 Eligibility and Application for Respite
Services.
(a)
Any family that has a member who is eligible for respite services
provided through an area agency in accordance with He‑M 503.03(a)‑(d)
or He-M 510.06(a) shall be eligible for respite services.
(b)
A family applying for respite services and no other service through the
developmental services system shall not be required to go through the complete
application process described in He‑M 503.04 and He-M 503.05 or He-M
510.06. The application process shall be
as set forth in (c) below.
(c) A family applying for respite services shall
submit:
(1) Documentation to enable the area agency to
determine whether the applicant has a developmental disability or acquired
brain disorder or is a child as defined in He-M 510.02(f);
(2) An explanation of the needs of the applicant
and family; and
(3) A description of the respite services
requested.
(d) Agency staff shall:
(1) Describe respite services to the applicant;
(2) Discuss with the applicant the needs of the
individual and family;
(3) Determine with the family the respite
services required and the amount of respite services to be allocated; and
(4) Assist the family in the selection of area agency or family arranged respite
services.
(e)
Prior to providing respite services, the area agency shall obtain the
following information from families and individuals requesting respite
services:
(1) The family's name, address, and telephone
number;
(2) The name, age, gender, and disability of the
individual;
(3) A description of respite services needs
identified by the family, such as location, dates, and times;
(4) Relevant medical information regarding the
individual, as applicable, including:
a. Prescribed medication;
b. Allergies;
c. Limitations on activities;
d. Special diets;
e. Assistive technology devices; and
f. Any other specific health or safety needs;
(5) The name and telephone number of at least one person to contact in an emergency; and
(6) The name and telephone number of the
individual's family physician or health care provider.
(f)
If an emergency circumstance prevents a family from being able to care
for an individual, the family may request respite services beyond the amount
determined under (d) above. In such
cases, the area agency shall approve respite services based on availability of
funds.
(g)
Providers who operate residences certified under He-M 1001.11, He-M
1001.12, or He-M 1001.13 shall not be eligible for respite services under He-M
513. Such providers may make arrangements
for provider time off through the area agency.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New. #6155, eff 12-29-95; ss by #8016, eff 12-29-03;
ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED:
6-17-20
New. #13263, eff
9-22-21
He-M 513.04 Agency Arranged Respite Services.
(a)
When respite services are provided by employees of an area agency or a
subcontractor of an area agency, the area agency or the subcontractor shall, at
a minimum:
(1) Discuss with the family their current respite
services needs;
(2) Encourage the family to use extended family,
neighbors, or other people known to the family as respite service providers,
whenever possible;
(3) At the request of the family, identify
potential respite service providers;
(4) Match respite service providers with eligible
individuals and families based on the individuals' and families' needs and preferences
and the skills and interests of the respite service providers;
(5) Arrange for a meeting with the individual,
the individual's family member or guardian, and the respite service provider
prior to the provision of respite services, whenever possible; and
(6) Assist the family to make the final
determination regarding respite service providers and where and when respite
services are to be provided.
(b)
Persons interested in providing respite services arranged by the area
agency shall apply to the area agency.
(c)
An application to be a respite service provider shall include:
(1) The
applicant’s:
a. Name;
b. Address;
c. Telephone number; and
d. Occupation;
(2) A photocopy of the applicant’s driver’s
license;
(3) The applicant’s training and experience in
the area of developmental disabilities;
(4) The time(s) and duration(s) of availability;
(5) The location(s) where respite services can be
provided;
(6) Any specific ability or inability of the
applicant to serve an individual with a particular type of disability; and
(7) The names, addresses, and telephone numbers
of 2 references unrelated to the applicant.
(d)
The area agency shall:
(1) Interview each applicant who submits a
completed application pursuant to (c) above;
(2) Request, verify, document, if necessary, and
retain 2 written or telephone references; and
(3) With the consent of the applicant:
a.
Submit the person’s name for review against the registry of founded
reports of abuse, neglect, and exploitation to ensure that the person is not on
the registry pursuant to RSA 161-F:49; and
b. Complete a criminal record check in New
Hampshire, in the applicant’s state of residence if not New Hampshire, and in
the applicants previous state of residence if he or she has lived in New
Hampshire for less than one year, ensure
that the applicant has no history of fraud, felony, or misdemeanor conviction.
(e) An area agency may hire a
person with a criminal record listed in (d)(3)b. above for a single offense that
occurred 10 or more years ago in accordance with (h) and (i) below. In such instances, the individual, his or her
guardian if applicable, and the area agency shall review the person’s history
prior to approving the person’s employment.
(f) Unless a waiver is granted
pursuant to (g) below, a provider agency shall not hire a person with a
criminal record, other than as specified in (e) above.
(g) The department shall grant
a waiver of (f) above if, after reviewing the underlying circumstances, it determines
that the person does not pose a threat to the health, safety, or well-being of
individuals.
(h) Employment of a person
pursuant to (e) above shall only occur if:
(1) Such employment is approved
in writing by the individual, or his or her guardian, if applicable;
(2) Such employment is approved
in writing by the area agency executive director or designee;
(3) The signature and phone
number of the person being hired are obtained;
(4) The employment does not
negatively impact the health or safety of the individual(s); and
(5) The employment does not
affect the quality of services to individuals.
(i) Upon hiring a person pursuant
to (e) above, the provider agency shall document and retain the following
information in the individual’s record:
(1) Identification of the
region, according to He-M 505.04, in which the provider agency is located;
(2) The date(s) of the approvals
in (e) above;
(3) The name of the individual
or individuals for whom the person will provide services;
(4) The name of the person
hired;
(5) Description of the person’s
criminal offense;
(6) The type of service the
person is hired to provide;
(7) The provider agency’s name
and address; and
(8) A full explanation of why
the agency is hiring the person despite the person’s criminal record;
(l) All personnel shall sign a
statement annually, which is maintained in the personnel file, stating that
since the time of hire they:
(1) Have not been convicted of
a felony or misdemeanor in this or any other state, and
(2) Have not had a finding by
the department or any administrative agency in this or any other state for
assault, fraud, abuse, neglect, or exploitation of any person.
(m)
For agency-arranged respite services, an applicant shall be denied
employment who:
(1) Is listed on the registry pursuant to RSA
161-F:49; or
(2) Refuses to consent to checks pursuant to
(d)(3) above.
(n)
If the respite services are to be delivered in the respite service provider’s
home, the home shall be visited by a staff member from the area agency prior to
the delivery of respite services.
(o)
The staff member who visited the respite service provider’s home shall
complete a report of the visit that includes a statement of acceptability of
the following conditions using criteria established by the area agency:
(1) The general cleanliness;
(2) Any safety hazards;
(3) Any architectural barriers for the
individual(s) to be served; and
(4) The adequacy of the following:
a. Lighting;
b. Ventilation;
c. Hot and cold water;
d. Plumbing;
e. Electricity;
f. Heat;
g. Furniture, including beds; and
h. Sleeping arrangements.
(p)
The following criteria shall apply to area agency-arranged respite
services:
(1) Respite service providers shall be able to
meet the day-to-day requirements of the person(s) served, including all of the
requirements listed in (v) below;
(2) Respite service providers giving care in
their own homes shall serve no more than 2 persons at one time; and
(3) Respite service providers shall contact the
area agency in the event that the provider is unable to meet the respite
service needs of the individual or comply with these rules.
(q)
Within 30 days, an area agency shall notify an applicant to be a respite
service provider of the status of the application based on compliance with (c),
(o), and (p) above.
(r) Each area agency shall arrange for training
of respite service providers in the following areas:
(1) The value and importance of respite services
to a family;
(2) The area agency mission statement and the
importance of family-centered supports and services as described in He-M
519.04(a);
(3) Basic health and safety practices including
emergency first aid;
(4) An overview of developmental disabilities and
acquired brain disorders;
(5) Understanding behavior as communication and
facilitating positive behaviors; and
(6) Other specialized skills as determined by the
area agency in consultation with the family.
(s)
If respite is to be provided in a residence certified under He‑M
1001.11, He-M 1001.12, He-M 1001.13, or He‑M 521.09, the respite service
provider shall be authorized to administer medication pursuant to He‑M
1201.
(t)
The area agency shall maintain a file on each respite service provider
that includes:
(1) Items and documentation described under
(c)-(o) and (s) above;
(2) Record of any training related to the
provision of respite services and provided subsequent to that shown on the
application;
(3) Dates and location(s) of service, individuals
served, and fees paid; and
(4) Evaluations by
the family, described in (v)-(w) below, of each service provided, or cross‑references
to individuals’ files where such evaluations are located.
(u)
The area agency shall provide or arrange for respite services and
provider training such that:
(1) Any special health, behavioral, or
communication needs of individuals can be met during the period of respite
services;
(2) Respite services to be provided are
appropriate to the individual’s needs and family-directed; and
(3) Activities normally engaged in by the
individual are included as part of the respite services.
(v)
Within one week following provision of area agency arranged respite
services by a respite service provider to a new family, area agency staff shall
contact the family in person, by telephone, or by questionnaire to review the
respite services provided.
(w)
The information collected as a result of the family contact shall:
(1) Be documented in writing and maintained at
the area agency;
(2) Minimally, address those service requirements
listed in (v) above; and
(3) Report the family's satisfaction or dissatisfaction
with the respite services provided.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New. #6155, eff 12-29-95; ss by #8016, eff
12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED: 6-17-20
New. #13263, eff 9-22-21
He-M 513.05 Family Arranged Respite Services.
(a) Any family approved by the area agency to
receive respite services may make its own arrangements for respite services
through the use of extended family, neighbors, or other people known to the
family.
(b) In circumstances where the family arranges
for respite services, all arrangements shall be at the discretion of, and be
the responsibility of, the family except as noted in (d) below.
(c) The area agency and family shall discuss the
available funds and establish compensation amounts and procedures for family
arranged respite services.
(d) If respite services are to be provided in a
residence certified under He-M 1001.11, He-M 1001.12, He-M 1001.13, or He-M
521.09, the respite service provider shall be trained in medication
administration pursuant to He-M 1201.
(e) The person primarily responsible for an
individual’s day-to-day care shall not provide and be reimbursed for respite
services for that individual.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New. #6155, eff 12-29-95; ss by #8016, eff
12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED: 6-17-20
New. #13263, eff 9-22-21
He-M 513.06 Role of Regional Family Support Councils.
(a)
Each area agency shall enter into an agreement with the regional family
support council, as described in He-M 519.05(c)(4), which details the regional
family support council's role in planning for the provision of respite services
within the region.
(b)
The regional family support council shall, at a minimum, make recommendations
to the area agency regarding the development and implementation of the area plan,
pursuant to He-M 505.03 (u), as it pertains to monitoring the quality of,
access to, and methods of providing respite services.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New. #6155, eff 12-29-95; ss by #8016, eff
12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED:
6-17-20
New. #13263, eff
9-22-21
He-M
513.07 Payment for Area Agency
Arranged and Family Arranged Respite Services.
(a) Area agencies may develop and use sliding
scale fees to determine the amount of the family’s payment, if any, for respite
services.
(b) A sliding fee scale pursuant to (a) above
shall:
(1) Be based on
family income; and
(2) Only apply
to families of individuals who are under the age of 18.
(c) Compensation shall be made by the area
agency, the family, or both to respite service providers for each hour or each
day that respite services are provided.
(d) Payment for respite services funded under the
HCBC‑DD waiver shall be in accordance with
He-M 517.10, medicaid covered home and community-based care services for persons
with developmental disabilities.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New. #6155, eff 12-29-95; ss by #8016, eff
12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED:
6-17-20
New. #13263, eff
9-22-21
He-M 513.08 Waivers.
(a)
An area agency, family member, respite service provider, or individual
may request a waiver of specific procedures outlined in He-M 513.
(b)
The entity requesting a waiver shall:
(1) Complete the
form entitled “NH Bureau of Developmental Services Waiver Request” (July 2019
edition); and
(2) Include a signature from the individual(s) or
legal guardian(s) indicating agreement with the request and the area agency’s
executive director or designee recommending approval of the waiver.
(c)
All information entered on the form described in (b) above shall be typewritten
or otherwise legibly written.
(d)
No provision or procedure prescribed by statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner or his or
her designee within 30 days if the alternative proposed by the requesting entity
meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not affect the quality of services to
individuals.
(f)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(g)
Upon receipt of approval of a waiver request, the grantee’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered essential compliance with the rule for which the waiver was
sought.
(h)
Waivers shall be granted in writing for the minimum period necessary to
accomplish the waiver request’s purpose, with the specific duration not to exceed 5 years.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
An area agency, family member, respite service provider, or individual
may request a renewal of a waiver from the bureau. Such request shall be made at least 90 days
prior to the expiration of a current waiver.
(k)
A request for renewal of a waiver shall be approved in accordance with
the criteria specified in (e) above.
Source. (See Revision Note at part heading for He-M
513) #4495, eff 9-23-88; EXPIRED: 9-23-94
New. #6155, eff 12-29-95; ss by #8016, eff
12-29-03; ss by #10030, eff 12-1-11, EXPIRED: 12-1-19
New. #12944, INTERIM, eff 12-20-19, EXPIRED:
6-17-20
New. #13263, eff 9-22-21
PART He-M 514 -
RESERVED
PART He-M 515 STANDARDS FOR INDIVIDUAL SKILLS TRAINING AND
PAYMENT - EXPIRED
Statutory
Authority: RSA 171-A:3; 4
REVISION NOTE:
Document #5131, effective 5-1-91, made
extensive changes to the wording, format, structure, and numbering of rules in
Part He-M 515. Document #5131 supersedes
all prior filings for the sections in this chapter. The prior filings for former Part He-M 515
include the following documents:
#2284, eff 12-29-82
#2819, eff 8-16-84
EXPIRED 8-16-90
He-M 515.01 - 515.10 - EXPIRED
Source. (See Revision Note at part heading for He-M
515) #5131, eff 5-1-91, EXPIRED: 5-1-97
PART He-M 516 -
RESERVED
Statutory
Authority: RSA 171-A:3; 4
REVISION NOTE:
Document #5049, effective 1-18-91, made
extensive changes to the wording, format, structure, and numbering of rules in
Part He-M 516. Document #5049 supersedes
all prior filings for the sections in this chapter. The prior filings for former Part He-M 516
include the following documents:
#2662, eff 3-30-84
EXPIRED 3-30-90
Source. (See Revision Note at part heading for He-M
516) #5049, eff 1-18-91, EXPIRED: 1-18-97
PART He-M 517 MEDICAID-COVERED HOME AND COMMUNITY-BASED
CARE SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES AND ACQUIRED BRAIN
DISORDERS
Statutory
Authority: RSA 171-A:3; 171-A:4;
171-A:18, IV; RSA 137-K:3, I, II,-IV
He-M 517.01 Purpose. The purpose of these rules is to define the
requirements and procedures for medicaid-covered home and community-based care
waiver services for persons with developmental disabilities and acquired brain
disorders where such services are provided pursuant to He-M 503, He-M 507, He-M
513, He-M 518, He-M 521, He-M 522, He-M 525, and He-M 1001.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; ss by #10454, eff 10-31-13
He-M 517.02 Definitions. The words and phrases in this chapter shall
have the following meanings:
(a) “Acquired brain disorder”
means a disruption in brain functioning that:
(1) Is not
congenital or caused by birth trauma;
(2) Presents
a severe and life-long disabling condition which significantly impairs a
person’s ability to function in society;
(3) Occurs
prior to age 60;
(4) Is
attributable to one or more of the following reasons:
a. External trauma to the brain as a result of:
1. A motor vehicle incident;
2. A fall;
3. An assault; or
4. Another related traumatic
incident or occurrence;
b. Anoxic or hypoxic injury to the brain such as
from:
1. Cardiopulmonary arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases such as encephalitis and
meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; or
h. Other neurological disorders, such as Huntington’s disease or multiple sclerosis,
which predominantly affect the central nervous system; and
(5) Is manifested by one or more
of the following:
a. Significant decline in cognitive functioning
and ability; and
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits.
(b)
“Agency residence” means a community residence operated by staff of an
area agency or an area agency subcontractor.
(c)
“Area agency” means “area agency” as defined under RSA 171-A:2, I-b,
namely, “an entity established as a non‑profit corporation in the state
of New Hampshire which is established by rules adopted by the commissioner to
provide services to developmentally disabled persons in the area.”
(d)
“Basic living skills” means activities
accomplished each day to acquire or maintain independence in daily life.
(e)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(f)
“Bureau administrator” means the chief administrator of the bureau of
developmental services or his or her designee.
(g)
“Centralized service site” means a location operated by a provider agency
where individuals receive community participation services for more than one
hour per day.
(h)
“Commissioner” means the commissioner of the department of health and
human services, or his or her designee.
(i)
“Community integration” means:
(1) Participation in a wide variety of
experiences in settings that are available to and used by the general public;
(2) Participation in natural relationships with
one’s family, friends, neighbors, and co-workers; and
(3) Expansion of one’s personal network of
friends to include individuals who do not have disabilities.
(j)
“Community residence” means either an agency residence or family
residence exclusive of any independent living arrangement that:
(1) Provides residential services for at least
one individual with a developmental disability, in accordance with He-M 503, or
acquired brain disorder in accordance with He-M 522;
(2) Provides services and supervision for an
individual on a daily and ongoing basis, both in the home and in the community,
unless the individual’s service agreement states that the individual may be
without supervision for specified periods of time;
(3) Serves individuals whose services are funded
by the department; and
(4) Is certified pursuant to He-M 1001, except as
allowed in He-M 517.04 (b).
(k)
“Cost of care” means the amount that an individual pays to an area
agency because the individual’s net income is above the applicable standard of
need established in He-W 658.03.
(l)
“Department” means the department of health and human services.
(m)
“Developmental disability” means “developmental disability” as defined
in RSA 171‑A:2, V, namely, “a disability:
(a)
Which is attributable to an intellectual disability, cerebral palsy,
epilepsy, autism or a specific learning disability, or any other condition of
an individual found to be closely related to an intellectual disability as it
refers to general intellectual functioning or impairment in adaptive behavior
or requires treatment similar to that required for persons with an intellectual
disability; and
(b)
Which originates before such individual attains age 22, has continued or
can be expected to continue indefinitely, and constitutes a severe handicap to
such individual’s ability to function normally in society.”
(n)
“Family” means a group of 2 or more persons that:
(1) Is related by marriage, ancestry, or other legal
arrangement;
(2) Is living in the same household; and
(3) Has at least one member who is an individual
as defined in (q) below.
(o)
“Family residence” means a community residence that is:
(1) Operated by a person or family residing
therein;
(2) Under contract with an area agency or
provider agency; and
(3) Certified pursuant to He-M 1001.
(p)
“Home and community-based care waiver” means the waiver of sections 1902
(a) (10) and 1915 (c) of the Social Security Act which allows the federal
Medicaid funding of long-term services for persons in non-institutional
settings who are elderly, disabled, or chronically ill.
(q)
“Individual” means a person who has a developmental disability as
defined in (m) above or an acquired brain disorder as defined in (a) above.
(r)
“Individualized family support plan (IFSP)” means a written plan for
providing services and supports to a child who is eligible for family-centered
early supports and services and his or her family.
(s)
“Natural supports” means people such as family, relatives, friends,
neighbors, and clergy, and social groups such as religious organizations,
co-workers, and social clubs, available to provide comfort and help as part of
everyday living as well as during critical events.
(t)
“Participant directed and managed services” means a service arrangement
whereby the individual or representative, if applicable, directs the services
and makes the decisions about how the funds available for the individual’s
services are to be spent. It includes assistance
and resources to individuals in order to maintain or improve their skills and
experiences in living, working, socializing, and recreating.
(u)
“Personal development” means supporting or increasing an individual’s
capacity to make choices, to communicate interests and preferences, and to have
sufficient opportunities for exploring and meeting those interests.
(v)
“Provider agency” means an area agency or an entity under contract with
an area agency that is responsible for providing services to individuals pursuant
to He-M 517.05.
(w)
“Representative” means:
(1)
The parent or guardian of an individual
under the age of 18;
(2)
The legal guardian of an individual 18
or over; or
(3) A person who has power of attorney for the individual.
(x) “Service
agreement” means a written agreement between an individual or guardian and the
area agency that describes the services that the individual will receive and
constitutes an individual service agreement as defined in RSA 171-A:2, X. The term includes a basic service agreement
for all individuals who receive services and an expanded service agreement for
those who receive more complex services pursuant to He-M 503.11.
(y)
“Service coordinator” means a person who is chosen or approved by an
individual and his or her guardian, if any, and designated by the area agency
to organize, facilitate and document service planning and to negotiate and
monitor the provision of the individual’s services and who is:
(1) An area agency service coordinator, family
support coordinator, or any other area agency or provider agency employee;
(2) A member of the individual’s family;
(3) A friend of the individual; or
(4) Another person chosen to represent the
individual.
(z)
“Sheltered workshop” means a segregated facility that provides a supportive
environment where individuals are employed and the focus is on meeting the
contract objectives of the agency.
(aa)
“Skilled nursing or skilled rehabilitative services” means those
services that:
(1) Require the skills of a licensed or certified
health professional including, but not limited to:
a. Registered nurse;
b. Licensed practical nurse;
c. Physical therapist;
d. Occupational therapist;
e. Speech pathologist;
f. Audiologist; or
g. Other similar health-related professional;
and
(2) Are provided directly by or under the general
supervision of such professionals to assure the safety of the individual and to
achieve the medically desired result.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; ss by #10454, eff 10-31-13
He-M 517.03 Eligibility.
(a)
Based on availability of funds, home and community-based care shall be
available to any individual who:
(1) Is found to be eligible for services by an
area agency pursuant to He-M 503.05, He-M 510.05 or He-M 522.03;
(2) Pursuant to He-M 517.08 (a), has also been
determined by the bureau to be eligible under He-M 503.05, He-M 510.05 or He-M
522.03;
(3) Is found to be eligible for medicaid by the department
pursuant to He-W 600, as applicable;
(4) Meets institutional level of care criteria as
demonstrated by one of the following:
a. A developmental disability that requires at
least one of the following:
1. Services on a daily basis for:
(i)
Performance of basic living skills;
(ii) Intellectual, physical, or psychological development
and well-being;
(iii) Medication administration and instruction in,
or supervision of, self-medication by a licensed medical professional; or
(iv) Medical monitoring or nursing care by a
licensed professional person;
2. Services
on a less than daily basis as part of a planned transition to more independence;
or
3. Services on a less than daily basis but with
continued availability of services to prevent circumstances that could necessitate more intrusive and costly services;
or
b. An acquired brain disorder that requires a
skilled nursing facility level of care, which means requiring skilled nursing
or skilled rehabilitative services on a daily basis; and
(5) Agrees to make the appropriate payment toward
the cost of care as specified in He-W 654.
(b)
The bureau shall deny services through the home and community-based care
waiver if it determines that the provision of services will result in the loss
of federal financial participation for such services.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; ss by #9370, eff 1-24-09;
ss by #10454, eff 10-31-13
He-M 517.04 Provider Participation.
(a)
Except as allowed by (b) below, all community residences shall be
certified pursuant to He-M 1001.
Community residences that serve 4 or more people shall also be licensed
by the bureau of health facilities administration in accordance with RSA 151:2,
I, (e) and He-P 814.
(b) A residence funded under the home and
community-based care waiver that provides services to persons with acquired
brain disorders and is licensed as a supported residential care facility or a
residential treatment and rehabilitation facility under RSA 151:2, I, (e) shall
not be required to be certified as a community residence pursuant to He-M 1001.
(c)
Personal care services described in He-M 521.03 and provided in the
family home of an individual who is 18 years of age or older shall be certified
pursuant to He-M 521.09.
(d)
Participant directed and managed
services described in He-M 525.05 shall be certified pursuant to He-M 525.07.
(e)
Area agencies shall be enrolled with the New Hampshire medicaid program
as providers in order to receive reimbursement for the provision of services
under the home and community-based care waiver.
(f)
An area agency or provider agency shall allow the bureau to examine its
service and financial records at any time for the purposes of audit or review.
(g)
When services are to be provided by a subcontractor of an area agency,
the area agency shall establish a contract specifying the roles of the area
agency and subcontractor agency in service planning, provision and oversight including:
(1) Implementation of the service agreement;
(2) Specific training and supervision required
for the service providers;
(3) Compensation amounts and procedures for
paying providers;
(4) Oversight of the service provision, as
required by the service agreement;
(5) Documentation of administrative activities
and services provided;
(6) Fiscal intermediary services provided by the
area agency or subcontractor agency to facilitate the delivery of
consumer-directed services;
(7) Quality assessment and improvement activities
as required by rules pertaining to the service provided;
(8) Compliance with applicable laws and rules,
including delegation of tasks by a nurse to unlicensed providers pursuant to
RSA 326-B and He-M 1201;
(9) Family support service coordination provided
by the area agency;
(10) Procedures for review and revision of the
service agreement as deemed necessary by any of the parties; and
(11) Provision for any of the parties to dissolve
the contract with notice.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; ss by #10454, eff 10-31-13
He-M 517.05 Covered Services.
(a)
All services provided in accordance with the home and community-based
care waiver shall be specifically tailored to, and provided in accordance with,
the individual’s needs, interests, competencies, and lifestyle as described in
the individual’s service agreement.
(b)
Services provided pursuant to He-M 517 shall be designed to maintain and
enhance each individual’s natural supports.
(c)
The services identified in (d)-(n) below shall be fundable in accordance
with the home and community-based care waiver if such services are identified
within an individual’s service agreement or IFSP.
(d)
Service coordination services shall:
(1)
Be provided pursuant to He-M 503.09 –
He-M 503.11 or He-M 522.10 – He-M 522.12;
(2) Include the following:
a. Monthly contacts, at a minimum, with the
individual or other people who support or serve the individual, unless more
frequent contacts are indicated by the service agreement;
b. Quarterly visits with the individual at the
individual’s residence or site of service, except when a different frequency is
required subsequent to provision of participant directed and managed services
pursuant to (n) below;
c. Quarterly determination of the individual’s
satisfaction with services through contact with the individual and his or her:
1. Family;
2. Guardian;
3. Friends; or
4. Service providers, as applicable to the
individual’s services;
d. Coordination and facilitation of all supports
and services delineated in the service agreement;
e. Development and revision of the service
agreement;
f. Monitoring, ongoing review and follow-up of
all service agreement services; and
g. Referral to the bureau for the assessment of
the individual’s continued need for waivered services pursuant to He-M 517.08;
and
(3) Be reimbursed at a monthly rate.
(e)
Personal care services shall:
(1) Be provided pursuant to He-M 1001.05, He-M
525.05, or He-M 521.03, as applicable;
(2) Consist of assistance, excluding room and
board, provided to individuals to improve or maintain their skills in basic
daily living, community integration, and personal development, as delineated in
the service agreement; and
(3)
Be reimbursed at a daily rate.
(f)
Community participation services shall:
(1)
Be provided in accordance with He-M
507.04;
(2) Include the following as required by the
individual’s service agreement:
a. Instruction and assistance to learn, improve,
or maintain:
1. Social and safety skills in different
community settings;
2. Decision-making regarding choice of and
participation in community activities;
3. Life skills as applied to community-based
activities, such as purchasing items and managing personal funds;
4. Good nutrition and healthy lifestyle;
5. Self-advocacy and rights and responsibilities
as citizens; and
6. Any other skill identified by the individual
or guardian during service planning and related to the individual’s
participation in, or contribution to, his or her community;
b. Supports to identify and develop the
individual’s interests and capacities related to securing employment opportunities,
including internships;
c. Services related to job development and
on-the-job training;
d. Assistance in finding and maintaining
volunteer positions;
e. Supports related to enabling the individual
to explore, and participate in, a wide variety of community activities and
experiences in settings that are available to the general public;
f. Consultation services as specified in the
service agreement to improve or maintain the individual’s communication,
mobility, and physical and psychological health and well-being; and
g. Transportation related to community
participation services, including travel
from the individual’s residence to locations where the community participation
service activities are taking place;
(3) Exclude employment or volunteer positions
where the individual is:
a.
Being solely supported by persons who are not providers; and
b.
Not receiving any services from a provider agency at those locations;
and
(4) Be reimbursed at a quarter hour rate.
(g)
Employment services shall:
(1) Be provided in accordance with He-M 518;
(2) Be available to any individual who:
a. Has an employment goal; and
b. Is not authorized and funded by the NH
department’ of education’s bureau of vocational rehabilitation for the same supported
employment service;
(3) Consist of assistance provided to individuals
to:
a.
Improve or maintain their skills in employment activities; or
b.
Enhance their social and personal development or well-being within the
context of vocational goals;
(4) Include referral, evaluation, and
consultation for adaptive equipment, environmental modifications, communications
technology or other forms of assistive technology, and educational opportunities
related to the individual’s employment services and goals;
(5) When combined with another employment
service, transportation and training in accessing transportation, as
appropriate, to and from work; and
(6) Be reimbursed at a quarter hour rate.
(h)
Respite care services shall:
(1) Be provided pursuant to He-M 513.04 or He-M
513.05;
(2) Consist of the provision of short-term
assistance, in or out of an individual’s home, for the temporary relief and
support of the family with whom the individual lives; and
(3) Be reimbursed at a quarter hour rate.
(i)
Environmental accessibility modifications shall:
(1) Include modifications or adaptations to the
individual’s home environment:
a.
To ensure his or her health and safety;
b.
That are required by the individual’s service agreement; and
c. That
are needed to accommodate the medical equipment and supplies that are necessary
for the welfare of the individual;
(2) Include modifications or adaptations to the
vehicle used by the individual in order to enable him or her to:
a.
Travel in greater safety;
b. Access
the community; and
c.
Carry out activities of daily living; and
(3) Comply with applicable state and local
building and vehicle codes.
(j)
Crisis response services shall:
(1) Consist of direct consultation, clinical
evaluation or support to an individual who is experiencing a behavioral,
emotional, or medical crisis in order to reduce the likelihood of harm to the
person or others and to assist the individual to return to his or her
pre-crisis status;
(2) Include training and staff development
related to the needs of the individual;
(3) Include on-call staff for the direct support
of the individual in crisis;
(4) Be authorized for a period of up to 6 months;
and
(5) Be reimbursed at a quarter hour rate.
(k)
Community support services shall:
(1) Be available for an individual who has developed,
or is trying to develop, skills to live independently within the community;
(2) Consist of assistance, excluding room and
board, provided to an individual to:
a. Improve or maintain his or her skills in
basic daily living and community integration; and
b. Enhance his or her personal development and
well-being; and
(3) Be reimbursed at a quarter hour rate.
(l)
Assistive technology support services shall:
(1) Consist of evaluation, consultation, or
education in the use, selection, lease, or acquisition of assistive technology
devices, as well as designing, fitting, and customizing of devices;
(2) Not cover the actual cost of assistive
technology devices; and
(3) Be reimbursed at quarter hour rates.
(m)
Specialty services shall:
(1) Be available to individuals whose medical,
behavioral, therapeutic, health or personal needs require services that are
particularly designed to address the unique conditions and aspects of their
developmental disabilities or acquired brain disorders;
(2) Consist of one or more of the following:
a. Assessment;
b.
Consultation;
c. Design,
development and provision of services;
d. Training and
supervision of staff and providers; and
e. Evaluation
of service outcomes;
(3) Include documentation indicating the nature
of the service, date, and number of units; and
(4) Be reimbursed at a quarter hour rate.
(n)
Participant directed and managed services shall:
(1) Be provided pursuant to He-M 525;
(2) Be available for individuals and their families
in order to improve or maintain each individual’s health and his or her
experiences and opportunities in work and community life;
(3) Consist of assistance and resources within a
flexible process that allows the family and individual to control, to the
extent desired, the service provision, including, for each service:
a. The type;
b. The amount;
c. The
location;
d. The
duration; and
e. The service
provider;
(4) Be based on a written proposal that includes:
a. A
description of the services to be provided that also specifies the expenditures
to be made;
b. A line-item
budget; and
c. A process
for measuring the individual’s degree of satisfaction with the services provided;
(5) Not be provided by the spouse of an
individual or the parent of an individual where the individual is a minor
child;
(6) Be provided by persons qualified pursuant to
He-M 506.03 in cases where services are provided by relatives other than parents or by friends;
and
(7) Be reimbursed monthly for services provided.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; amd by #9370, eff 1-24-09;
ss by #10454, eff 10-31-13
He-M 517.06 Non-Covered Services. The following services shall not be fundable
under home and community-based care waivers:
(a)
Educational services or education programs for individuals who are under
21 years of age that are the responsibility of the local education authority;
(b)
Post-secondary education;
(c)
Sheltered workshop services; and
(d)
Custodial care programs provided only to maintain an individual’s basic
welfare.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; ss by #10454, eff 10-31-13
He-M 517.07 Documentation.
(a)
Providers of home and community‑based care for persons with
developmental disabilities or acquired brain disorders shall maintain the
documentation described in (b)-(k) below at the sites where services are
provided.
(b)
Service coordination records shall include:
(1) Information about the individual that would
be essential in case of an emergency, including:
a. Name, address, and telephone number of legal
guardian or next of kin; and
b. Medical information, including:
1. Diagnosis(es);
2. Health history;
3. Medications, including dose, frequency, and
route;
4. Allergies;
5. Do not resuscitate (DNR) status; and
6. Advance directives;
(2) A copy of each individual’s service
agreement;
(3) Copies of all service agreement revisions
approved by the individual or his/her guardian;
(4) Progress notes on goals for which the service
coordinator has primary responsibility;
(5) Monthly documentation by the service
coordinator of service coordination activities, including activities promoting
community participation and integration;
(6) At least quarterly documentation assessing
progress on goals and identifying whether the services:
a. Match the interests and needs of the
individual;
b. Met with the individual’s and guardian’s
satisfaction; and
c. Meet the terms of the service agreement;
(7) Copies of all evaluations and reviews by
providers and professionals;
(8)
Copies of correspondence within the past year with the individual or guardian,
service providers, physicians, attorneys, state and federal agencies, family
members and others in the individual’s
life with whom the service coordinator has corresponded; and
(9) Other correspondence or memoranda concerning
any significant events in the individual’s life.
(c)
For services provided in a community residence pursuant to He-M 1001,
personal care services documentation shall include:
(1) Individual records, which shall include:
a. Information about the individual that would
be essential in case of an emergency, including that information specified in
(b)(1) above;
b. The portion of the service agreement
pertaining to residential services, with any revisions; and
c. Monthly progress notes;
(2) Community residence daily service provision
records, which shall:
a. Be completed by the service provider;
b. Include the date;
c. Indicate each individual’s daily presence or
absence;
d. If the individual is not present, indicate
the date and time of the individual’s departure and return, and include the
reason for the absence;
e. For those community residences where
supervision is less than 24 hours a day, indicate the days in which services
were provided; and
f. Be on file at both the community residence
and the area agency; and
(3) A daily medication log, which shall be
completed at the residence pursuant to He-M 1201.07.
(d)
For services provided in a family home pursuant to He-M 521, personal
care services documentation shall include:
(1) Individual records, which shall include:
a. Information about the individual that would
be essential in case of an emergency, including that information specified in
(b)(1) above;
b. The portion of the service agreement
pertaining to residential services with any revisions; and
c. Monthly progress notes; and
(2) Daily service provision records, which shall:
a. Be completed by the service provider;
b. Include the date; and
c. Indicate days that services were provided.
(e)
For community participation services pursuant to He-M 507, individual
records shall include:
(1) A copy of the current service agreement
containing:
a.
Goals and desired outcomes specific to the individual’s participation in
community participation services; and
b.
The methods or strategies for achieving the individual’s community
participation services’ goals and desired outcomes;
(2) As a guide for planning activities, an
individual, week-long, personal schedule or calendar that is created at the
time of the annual service planning meeting and, if applicable, identifies:
a.
The days, times, and locations of the individual’s:
1. Paid employment;
2. Community activities, volunteerism, or
internship; and
3. Other regularly
recurring activities, such as therapeutic activities related to communication,
mobility, and personal care; and
b.
The days and approximate times of unspecified community activities,
which shall not exceed 20% of the total day service hours the individual
receives per week;
(3) A record of daily community participation
services activities maintained by the provider agency, which shall include the
following:
a.
The name(s) of individual(s) served and names of staff supporting them;
b.
The dates on which services were provided; and
c.
Activities that took place and the locations of the activities;
(4) Narrative progress notes, and other service
documentation as specified in the service agreement, recorded at least monthly,
and addressing:
a.
The individual’s community participation services goals and actual
outcomes; and
b. Other activities related to the
individual’s support services, health, interests, achievements, and
relationships;
(5) The individual’s medical status, including
current medications, known allergies, and other pertinent health care
information;
(6) Results of any screenings or evaluations
including, if applicable:
a.
The Supports Intensity Scale (2004 edition), available as noted in
Appendix A;
b.
Vocational assessments;
c.
Results of any assistive technology assessments;
d.
The Health Risk Screening Tool (HRST) (2009 edition), available as noted
in Appendix A;
e. Systematic, therapeutic, assessment,
respite and treatment (START) in-depth assessments and crisis plans; and
f.
Risk management plans for individuals who are deemed to pose a risk to
community safety; and
(7) For each individual for whom medications are
administered during community participation services, medication log
documentation pursuant to He-M 1201.07.
(f)
Individual records for employment services shall include:
(1) Information about the individual that would
be essential in case of an emergency, including that information specified in
(b)(1) above;
(2) The portion of the service agreement
pertaining to employment services, with any revisions;
(3) Quarterly progress notes regarding services
provided and progress toward goals identified in the service agreement;
(4) Weekly work schedules; and
(5) If there is a provider agency staff person
with the individual or individuals at the job site:
a. Service provision records, including
documentation of the individual’s attendance at work; and
b. As needed, notation of any employment-related
events apart from each individual’s expected work routine.
(g)
Respite service records shall include attendance records indicating the
dates and duration of the services provided.
(h)
Environmental accessibility modifications documentation shall include:
(1) A specific description of the modifications
and estimate(s) of cost;
(2) A rationale as to why the requested modification
is specifically related to the individual’s disability;
(3) The section of the individual’s service
agreement or IFSP that specifies the need for the modifications; and
(4) The date of completion.
(i)
Crisis response documentation shall include:
(1) A brief description of the crisis written by
the service coordinator;
(2) An initial summary of the crisis response
services proposed;
(3) Monthly progress notes, including a
description of the services provided and the individual’s response to services;
and
(4) Service provision records indicating the
units of services provided.
(j)
Community support services documentation shall include:
(1) Individual records, which shall include:
a. Information about the individual that would
be essential in case of an emergency, including that information specified in
(b)(1) above;
b. A service agreement with all approved
revisions; and
c. Monthly progress notes; and
(2) Service provision records indicating the
units of services provided.
(k)
Participant directed and managed services documentation shall include:
(1) Individual records, including:
a. Information about the individual that would
be essential in case of an emergency, including that information specified in
(b)(1) above;
b. The portion of
the individual’s service agreement pertaining to participant directed and
managed services, with any revisions;
c. Monthly progress notes;
d. Monthly notes describing the family’s
satisfaction with the services; and
e. Monthly financial statements provided to the
individual and family by the area agency or representative; and
(2)
Detailed description of all services
provided, including:
a. The date;
b. The activity or type of service;
c. The location;
d. The duration; and
e. The provider.
(l)
Assistive technology support services documentation shall include:
(1) A brief statement in the service agreement or
IFSP describing the need for assistive technology support services;
(2) A report of any evaluation or consultation
performed, with recommendations;
(3) A report regarding the nature of the services
provided;
(4) Records indicating the dates and units of
services provided; and
(5) For lease of assistive technology equipment,
a written proposal for the cost of the lease.
(m)
Each provider agency shall retain individual records for a period of 7
years following the termination of services to an individual.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; amd by #9370, eff 1-24-09;
ss by #10454, eff 10-31-13
He-M 517.08 Utilization Control.
(a)
Recipients shall undergo an initial determination of eligibility and
annual reassessment of the need for continued services. The bureau shall determine the need for
services based on the criteria specified in He-M 517.03.
(b)
To request determination of eligibility and service authorization for
home and community-based care services for an individual, the area agency shall
complete and submit to the bureau through Xerox Provider Services a “NH bureau
of developmental services functional screen for waiver services” form (edition
5/22/13) at least 30 days prior to initiation of the services or at least 30
days prior to expiration of the current authorization.
(c)
In the case of environmental modification or vehicle requests in excess
of $5,000, each request shall include 2 cost estimates.
(d)
To request prior authorization of a change in covered services within a
current authorization period, the area agency shall complete and submit:
(1) A written request for authorization of the
change; and
(2)
An updated “NH bureau of developmental services functional screen for waiver
services” form (edition 5/22/13).
(e) The bureau shall approve or deny
requests for prior authorization of services following determination of the
need for services pursuant to He‑M 517.03.
(f)
If information submitted pursuant to (b) or (d) above, or similar
information obtained at any other time by the bureau, indicates that an
individual might no longer meet the criteria for home and community-based care
specified in He-M 517.03 (a)(4) a. or b., the bureau shall redetermine the individual’s
eligibility pursuant to (b)-(e) above.
(g)
For initial service determinations and annual reviews of eligibility,
the department shall notify:
(1) The area agency, the department’s district
office, and Xerox of approvals; and
(2) The area agency of denials, including the
reason.
(h)
In every case of denial of a request for prior authorization of
services, the area agency shall notify the individual affected, in writing, of
the decision and the reasons for the denial.
(i) Notification pursuant
to (g) above shall include:
(1) The specific rules that support, or the
federal or state law that requires, the action;
(2) An explanation of the individual’s right to
request an appeal and the procedure and timelines set forth in He-M 517.09;
(3) Notice that the individual has the right to
have representation with an appeal by:
a.
Legal counsel;
b.
A relative;
c.
A friend; or
d.
Another spokesperson;
(4) Notice that neither the area agency nor the
bureau is responsible for the cost of representation; and
(5) Notice of organizations that might offer
assistance or representation to the individual, including pro bono or reduced
fee assistance.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; amd by #9370, eff 1-24-09;
ss by #10454, eff 10-31-13
He-M 517.09 Appeals.
(a)
Within 30 working days of receipt of a final decision as described in
He-M 517.03 or pursuant to He-M 517.08 (h), the individual or guardian may
appeal in accordance with He-C 200.
(b)
Appeals shall be forwarded to the bureau administrator, in writing, in
care of the department’s office of client and legal services.
(c)
The bureau administrator shall immediately forward the appeal to the
department’s administrative appeals unit which shall assign a presiding officer
to conduct a hearing or independent review, as provided in He-C 200. The burden shall be as provided by He-C
203.14.
(d)
If a hearing is requested, the following actions shall occur:
(1) For current recipients, services and payments
shall be continued as a consequence of an appeal for a hearing until a decision
has been made; and
(2) If the bureau’s decision is upheld, benefits
shall cease 60 days from the date of the denial letter or 30 days from the
hearing decision, whichever is later.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05; ss by #10454, eff 10-31-13
He-M 517.10 Payment.
(a)
Community-based care providers shall submit claims for covered community‑based
care services to:
Xerox
Provider Services
ATTN: Claims Administration
PO Box
2003
Concord,
NH 03302-2003
(b)
Payment for community-based care services shall only be made if prior
authorization has been obtained from the bureau pursuant to He-M 517.08 (c).
(c)
Requests for prior authorization shall be made electronically utilizing
the NH Medicaid Management Information System or in writing to:
Xerox
Provider Services
ATTN: Claims Administration
PO Box
2003
Concord,
NH 03302-2003
(d)
For those individuals whose net income exceeds the appropriate standard
of need, medicaid claims payment will reflect a reduction in reimbursement equal
to the cost of care amount.
(e)
Payment for community-based care services shall not be available to any
service provider who:
(1) Is the parent of an individual under age 18;
(2) Is a person under age 18; or
(3) Is the spouse of an individual receiving
services.
Source. #4315, eff 9-25-87; EXPIRED: 9-25-93
New. #6360, eff 10-23-96, EXPIRED: 10-23-04
New. #8195, INTERIM, eff 10-29-04, EXPIRED:
4-27-05
New. #8424, eff 9-1-05 (from He-M 517.09) ; ss by
#10454, eff 10-31-13
He-M 517.11 Waivers.
(a) An applicant,
area agency, provider agency, individual, guardian, or provider may request a
waiver of specific procedures outlined in He-M 517 using the form titled “NH
bureau of developmental services waiver request” (September 2013
edition). The
area agency shall submit the request in writing to the bureau administrator.
(b) A completed waiver
request form shall be signed by:
(1) The individual or guardian indicating agreement
with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c) A waiver request shall be submitted to:
Department of Health and Human Services
Office of Client and Legal Services
Hugh J. Gallen State Office Park
105 Pleasant Street, Main Building
Concord, NH 03301
(d)
No provision or procedure prescribed by statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner within 30
days if the alternative proposed by the requesting entity meets the objective
or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not affect the quality of services to
individuals.
(f)
Upon receipt of approval of a waiver request, the requesting entity’s
subsequent compliance with the alternative provisions or procedures approved in
the waiver shall be considered compliance with the rule for which waiver was
sought.
(g)
Waivers shall be granted in writing for a specific duration not to
exceed 5 years except as in (h) below.
(h)
Those waivers which relate to other issues relative to the health,
safety or welfare of individuals that require periodic reassessment shall be
effective for the current certification period only.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
A requesting entity may request a renewal of a waiver from the bureau. Such request shall be made at least 90 days
prior to the expiration of a current waiver.
Source. #8424, eff 9-1-05 (from He-M 517.10); ss by
#10454, eff 10-31-13
PART He-M 518 EMPLOYMENT SERVICES
Statutory Authority: NH RSA 171-A:3; 171-A:18, IV; 137-K:3, IV
He-M 518.01 Purpose. The purpose of these rules is to:
(a)
Establish the requirements for employment services for persons with
developmental disabilities and acquired brain disorders served within the state
community developmental services system who have an expressed interest in
working;
(b)
Provide access to comprehensive employment services by staff qualified
pursuant to He-M 518.10; and
(c)
Make available, based upon individual need and interest:
(1) Employment;
(2) Training and educational opportunities; and
(3) The use of co-worker supports and generic resources,
to the maximum extent possible.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss by #8406, eff 8-22-05;
ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14
He-M 518.02 Definitions.
(a)
“Acquired brain disorder” means a disruption in brain functioning that:
(1) Is not congenital or caused by birth trauma;
(2) Presents a severe and life-long disabling
condition which significantly impairs a person’s ability to function in
society;
(3) Occurs prior to age 60;
(4) Is attributable to one or more of the
following reasons:
a. External trauma to the
brain as a result of:
1. A motor vehicle incident;
2. A fall;
3. An assault; or
4. Another related traumatic incident or
occurrence;
b. Anoxic or hypoxic injury
to the brain such as from:
1. Cardiopulmonary arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases such
as encephalitis and meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular
disruption such as a stroke;
g. Toxic exposure; and
h. Other neurological
disorders such as Huntington’s disease or multiple sclerosis which predominantly
affect the central nervous system; and
(5) Is manifested by one or more of the
following:
a. Significant decline in
cognitive functioning and ability; or
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits.
(b)
“Area agency” means an entity established as a non‑profit
corporation in the state of New Hampshire which is established by rules adopted
by the commissioner to provide services to persons with developmental
disabilities or aquired brain disorders in the area.
(c)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(d)
“Bureau of vocational rehabilitation” means the New Hampshire department
of education, bureau of vocational rehabilitation.
(e)
“Career exploration” means as part of the career planning process,
selection by an individual of a job, training, or educational path that fits
his or her interests, skills and abilities.
(f)
“Career planning” means a time-limited, person-centered, comprehensive,
employment planning process that assists an individual to identify a career
direction and results in a plan for achieving employment at or above minimum
wage.
(g)
“Career portfolio” means a tool used to organize and document training,
education, work experiences, skills, contributions and accomplishments.
(h)
“Customized employment” means the individualizing of the
employment relationship between employees and employers in ways that meet the
needs of both. It is based on an individualized determination of the strengths,
needs, and interests of the individual, and is also designed to meet the specific
needs of the employer.
(i)
“Developmental disability” means “developmental disability” as defined
in RSA 171‑A:2, V, namely, “a disability:
(a) Which is attributable to an intellectual
disability, cerebral palsy, epilepsy, autism or a specific learning disability,
or any other condition of an individual found to be closely related to an
intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability; and
(b) Which originates before such individual attains
age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe handicap to such individual’s ability to function normally
in society.”
(j)
“Employee” means an individual who receives wages in exchange for work
rendered in an integrated setting.
(k)
“Employment” means working for at least minimum wage in an integrated
setting or being self-employed.
(l)
“Employment profile” means a summary of an individual’s
vocationally-related:
(1) Competencies;
(2) Interests;
(3) Preferences;
(4) Learning style;
(5) Environmental considerations; and
(6) Supports.
(m)
“Fading plan” means a specific plan that is developed to assist an
individual to achieve maximum independence on the job through a variety of
activities including cultivating natural supports.
(n)
“Hard skills” means the essential skills required to perform a job such
as, but not limited to:
(1) Operating machinery;
(2) Using a computer;
(3) Providing customer service; and
(4) Typing.
(o)
“Individual” means any person with a developmental disability or
acquired brain disorder who receives, or has been found eligible to receive,
area agency services.
(p)
“Integrated setting” means a workplace where people with disabilities
work alongside other employees who do not have disabilities and where they have
the same opportunities to participate in all activities in which other
employees participate.
(q)
“Job coaching” means the training
of an employee through structured intervention techniques to help the employee
learn to perform job tasks to the employer’s specifications and to learn the
interpersonal skills necessary to be accepted as a worker at the job site and
in related community contacts.
(r)
“Job development” means contacting and connecting with employers to identify,
develop, or customize jobs suited to individuals’ skills and interests.
(s)
“National core indicators” means standard measures compiled by the National
Association of State Directors of Developmental Disabilities Services and the
Human Services Research Institute and used across states to assess the outcomes
of services provided to individuals and families. Indicators address key areas
of concern including employment, rights, service planning, community inclusion,
choice, and health and safety. National
core indicators are published as annual reports, state reports, and consumer
outcomes reports, and are available at http://www.nationalcoreindicators.org/.
(t)
“Natural support” means support wherein a community business provides
direct training, supervision, or assistance to an employee.
(u)
“Provider agency” means an area agency or subcontractor of an area agency
that offers employment services.
(v)
“Safeguards” means specific measures taken to protect the individual from
harm or loss.
(w)
“Service agreement” means a written agreement pursuant to He-M 503.10 –
He-M 503.11 between an individual or guardian and the area agency that
describes the services that the individual will receive and constitutes an individual
service agreement as defined in RSA 171-A:2, X.
(x)
“Service coordinator” means a person who is chosen or approved by an
individual or his or her representative and designated by the area agency to
organize, facilitate, and document service planning and to negotiate and monitor
the provision of the individual’s services, and who is:
(1) An area agency service coordinator, family
support coordinator, or any other area agency or subcontract agency employee;
(2) A member of the individual’s family;
(3) A friend of the individual; or
(4) Any other person chosen by the individual.
(y)
“Soft skills” means the interpersonal skills required to be successful
in a job, such as:
(1) Effective communication;
(2) Managing emotions;
(3) Conflict resolution;
(4) Creative problem solving;
(5) Critical thinking; and
(6) Team building.
(z)
“Work incentives” means special regulations developed by the Social
Security Administration making it possible for people with disabilities
receiving Social Security or Supplemental Security Income (SSI) to work and
still receive monthly payments and Medicare or Medicaid, including:
(1) Trial work period, 20 CFR 404.1592;
(2) Impairment related work expenses, 20 CFR 404.1576;
(3) Extended period of eligibility, 20 CFR
404,1592a;
(4) Extended Medicare coverage for Social
Security Disability Insurance, 42 CFR 406.12(e);
(5) Earned income exclusion, 20 CFR 418.3325;
(6) Continued Medicaid eligibility, section
1619(b) of the Social Security Act;
(7) Plan to achieve self-support, 20 CFR
416.1225;
(8) Ticket to work program, 20 CFR part 411,
subpart B;
(9) Impairment-related work expenses, 20 CFR
404.1576;
(10) Expedited reinstatement, 20 CFR 416.999;
(11) Unsuccessful work attempt, 20 CFR 416.974; and
(12) Medicaid for employed adults with
disabilities (MEAD), pursuant to He-W 504.
(aa)
“Work incentives planning” means specific planning around earning
income, managing public benefits, and accessing work incentives.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss by #8406, eff 8-22-05;
ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14
He-M 518.03 Service Principles.
(a) All employment services
shall be designed to:
(1) Assist the individual to obtain employment or
self-employment that is based on the individual’s employment profile and goals
in the service agreement;
(2) Provide the individual with opportunities to
participate in a comprehensive career development process that helps to
identify, in a timely manner, the individual’s employment profile;
(3) Support the individual to develop appropriate
skills for job searching, including:
a. Creating a resume and
employment portfolio;
b. Practicing job interviews;
and
c. Learning soft skills
that are essential for succeeding in the workplace;
(4) Assist the individual to become as
independent as possible in his or her employment, internships, and education
and training opportunities by:
a. Developing accommodations;
b. Utilizing assistive
technology; and
c. Creating and implementing
a fading plan;
(5) Help the individual to:
a. Meet his or her goal for
the desired number of hours of work as articulated in the service agreement;
and
b. Earn wages of at least
minimum wage or prevailing wage, unless the individual is pursuing income based
on self-employment;
(6) Assess, cultivate, and utilize natural supports
within the workplace to assist the individual to achieve independence to the
greatest extent possible;
(7) Help the individual to learn about, and
develop appropriate social skills to actively participate in, the culture of
his or her workplace;
(8) Understand, respect, and address the business
needs of the individual’s employer, in order to support the individual to meet
appropriate workplace standards and goals;
(9) Maintain communication with, and provide
consultations to, the employer to:
a. Address employer
specific questions or concerns to enable the individual to perform and retain
his/her job; and
b. Explore opportunities
for further skill development and advancement for the individual;
(10) Help the individual to learn, improve, and
maintain a variety of life skills related to employment, such as:
a. Traveling safely in the
community;
b. Managing personal funds;
c. Utilizing public
transportation; and
d. Other life skills
identified in the service agreement related to employment;
(11) Promote the individual’s health and safety;
(12) Protect the individual’s right to freedom
from abuse, neglect, and exploitation; and
(13) Provide opportunities for the individual to
exercise personal choice and independence within the bounds of reasonable
risks.
(b) An individual or
guardian may select any person, any provider agency, or another area agency as
a provider to deliver the employment services identified in the individual’s
service agreement in accordance with He-M 518.05 and He-M 518.10.
(c) All providers of
employment services shall:
(1) Comply with the rules pertaining to
employment services;
(2) Enter into a contractual agreement with the
area agency;
(3) Operate within the limits of funding
authorized by the agreement; and
(4) Meet the needs of the individual while taking
into account the interests and obligations of the employer.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss by #8406, eff 8-22-05;
ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14
He-M 518.04 Eligibility For Employment Services.
(a)
Any individual who receives services through the area agency system and
who has an employment goal shall be eligible for employment services.
(b)
The determination or confirmation that the individual has an employment
goal and desires services shall occur at or by:
(1) The preliminary recommendations for services
process under He-M 503.07(a)(1);
(2) The service planning required by He-M 503.10;
(3) The transition process described in Ed
1109.01 (a)(10) for youth aged 14 through 20 who are in school; or
(4) Any other informal or formal means by which
the individual expresses a desire to work.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss by #8406, eff 8-22-05;
ss by #10397, INTERIM, eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14
(from He-M 518.03)
He-M 5l8.05 The Individual Employment Planning Process.
(a) As part of the service planning process, the
individual’s service coordinator shall include employment planning for each
individual seeking or receiving employment services.
(b) The employment planning process shall:
(1) Be led by an employment professional qualified
pursuant to He-M 518.10 (h); and
(2) Include:
a. A vocational evaluation
or an assessment of employment interests and capacities;
b. Development of an
employment profile to include:
1. Learning style;
2. Environmental needs;
3. Medical needs;
4. Physical needs; and
5. Safety needs;
c. Career exploration;
d. Goal setting;
e. Development of soft
skills;
f. Development of hard
skills through:
1. Internships;
2. Sector-based training;
3. Continuing education;
4. On-the-job training; and
5. Unpaid work experiences;
g. Development of strategies
for achieving employment;
h. Transportation planning
and training to independently use transportation options;
i. Community safety skills
training; and
j. Work incentives planning.
(c) The service agreement for each individual who
receives employment services shall include:
(1) An employment profile of the individual;
(2) A resume and employment portfolio;
(3) Employment goal(s) and strategies with
specific timeframes for achieving the goal(s) that include:
a. Skills training;
b. Increased
responsibilities;
c. Career advancement;
d. Increased wages;
e. Increased hours worked;
f. Change in employment; and
g. Any other identified goals;
(4) Referral to the bureau of vocational
rehabilitation;
(5) Identification of the roles and responsibilities
of team members in implementing the goal(s) and service(s); and
(6) Identification of any of the services listed
in He-M 518.07 to achieve the goal(s).
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss and moved by #8406,
eff
8-22-05 (from He-M 518.06); ss by #10397, INTERIM,
eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14 (from He-M 518.04)
He-M 518.06 Wages.
(a)
All wages shall be paid to employees in accordance with the Fair Labor Standards
Act as specified in 29 U.S.C. 201 et seq., and any other applicable state and
federal statutes, rules, and regulations.
(b)
Whenever possible, wages shall be in the form of payment made directly
to the employee by the employer.
(c)
In those situations when payments are made to the employee by the
provider agency, wages shall be set based on the minimum wage pursuant RSA
279:21.
(d)
In no event shall Medicaid or bureau funds be used directly to pay or
subsidize wages otherwise earned by employees.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss and moved by #8406, eff
8-22-05 (from He-M 518.07); ss by #10397, INTERIM,
eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14 (from He-M 518.05)
He-M 518.07 Covered Services.
(a)
All employment services shall:
(1) Be designed in accordance with the individual’s
specific needs, interests, competencies, and learning style, as described in
the individual’s service agreement and employment profile as defined in He-M 503.02
(l); and
(2) Assist each individual to assume as much personal
responsibility in job seeking and job retention as is possible for that
individual.
(b) Payments for employment services shall cover:
(1) All services identified in He-M 518.05;
(2) Job development;
(3) Assistance, as needed, with employment
including:
a. Job applications;
b. Resume-writing;
c. Obtaining references;
d. Development of a career
portfolio;
e. Interview preparation;
and
f. All other activities
related to obtaining and maintaining employment except as described in (10)
below;
(4) Training for the individual to learn the responsibilities
and expectations of employment, including:
a. Acquiring or developing
acceptable work standards and workplace behavior;
b. Adjusting to the job
site and work culture; and
c. Using accommodations,
including any customized modifications made to perform the job;
(5) Implementation of the fading plan;
(6) Consultations or contacts with the businesses
and the individual, as needed, to assist the individual to remain successfully
employed;
(7) Outreach to employers for building relationships
that lead to immediate or future job opportunities for the individual;
(8) Training for direct support staff as it
relates to the individual’s employment goals;
(9) Training for employers and co-workers to
support the individual by understanding his or her:
a. Learning style;
b. Environmental needs;
c. Medical needs;
d. Physical needs; and
e. Safety needs;
(10) When combined with another employment
service, transportation and training in accessing transportation, as
appropriate, to and from work;
(11) Referral, evaluation, and consultation for
adaptive equipment, environmental modifications, communications technology or
other forms of assistive technology, and educational opportunities related to
the individual’s employment services and goals;
(12) Accessing work incentives information and work
incentives planning services for the individual; and
(13) Any other employment service identified in the
individual’s service agreement.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff
8-22-97; ss and moved by #8406,
eff 8-22-05 (from He-M 518.09); ss by #10397, INTERIM, eff 8-22-13, EXPIRES:
2-18-14; ss by #10493, eff 2-18-14 (from He-M 518.06)
He-M 518.08 Employment Planning for Youth Aged 14 through
20 Years in School.
(a)
Beginning at age 14, the individual and his or her family and school
personnel shall be given information by the area agency staff regarding:
(1) The employment services that are available
within the adult service system;
(2) The importance of planning ahead for
achieving successful employment outcomes in the future;
(3) Work incentives planning; and
(4) The bureau of vocational rehabilitation as a
source of assistance regarding employment opportunities.
(b)
In their communications with the individual, family and schools, area
agency staff shall continuously reinforce the importance of employment
opportunities and facilitate as applicable, their development.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss and moved by #8406,
eff
8-22-05 (from He-M 518.10); ss by #10397, INTERIM,
eff 8-22-13, EXPIRES: 2-18-14; ss by #10493, eff 2-18-14
He-M 518.09 Records and Reporting. Each provider agency shall:
(a)
Maintain records for all individuals receiving services pursuant to He-M
518, including the following:
(1) Service provision records;
(2) The results of any relevant assessments or
evaluations;
(3) The individual’s service agreement;
(4) An individual week-long work schedule or
calendar;
(5) The individuals employment profile;
(6) The individual’s employment history; and
(7) At a minimum, quarterly narrative progress
notes and other service documentation, as specified in the service agreement;
and
(b)
At least annually, assess the employment service through interviews with
employers, individuals, and guardians.
Source. #4593, eff 4-1-89; EXPIRED: 4-1-95
New. #6569, eff 8-22-97; ss and moved by #8406,
eff
8-22-05 (from He-M 518.11) ); ss by #10397, INTERIM, eff 8-22-13, EXPIRES:
2-18-14; ss by #10493, eff 2-18-14 (from He-M 518.07)
He-M 518.10 Staff Qualifications and Responsibilities.
(a)
Each provider agency shall have:
(1) A sufficient number of personnel, qualified
pursuant to (c) below, available to meet the individual and collective
employment-related needs of each individual served; and
(2) Staff who meet the requirements of (h) or (i)
below.
(b) Prior to a person providing employment
services to individuals, the provider agency, with the consent of the person,
shall:
(1) Obtain at least 2 references for the person;
(2) Complete, at a minimum, a New Hampshire criminal
records check;
(3) If a person’s primary residence is out of
state, complete a criminal records check for the person’s state of residence;
and
(4) If a person has resided in New Hampshire for
less than one year, complete a criminal records check for the person’s previous
state of residence.
(c) Except as allowed in (d)-(f) below, the
provider agency shall not hire a person:
(1) Who has a:
a. Felony conviction; or
b. Any misdemeanor
conviction involving:
1. Physical or sexual assault;
2. Violence;
3. Exploitation;
4. Child pornography;
5. Threatening or reckless conduct;
6. Theft;
7. Driving under the influence of drugs or alcohol;
or
8. Any other conduct that represents evidence of
behavior that could endanger the well being of an individual; or
(2) Whose name is on the registry of founded
reports of abuse, neglect, and exploitation pursuant to RSA 161-F:49.
(d)
A provider agency may hire a person with a criminal record listed in
(c)(1)a. or b. above for a single offense that occurred 10 or more years ago in
accordance with (e) and (f) below. In
such instances, the individual, his or her guardian, and the area agency shall
review the person’s history prior to approving the person’s employment.
(e)
Employment of a person pursuant to (d) above shall only occur if such
employment:
(1) Is approved by the individual, his or her guardian,
and the area agency;
(2) Does not negatively impact the health or safety
of the individual(s); and
(3) Does not affect the quality of services to
individuals.
(f)
Upon hiring a person pursuant to (d) above, the provider agency shall
document and retain the following information in the individual’s record:
(1) Identification of the region, according to
He-M 505.04, in which the provider agency is located;
(2) The date(s) of the approvals in (e) above;
(3) The name of the individual or individuals for
whom the person will provide services;
(4) The name of the person hired;
(5) Description of the person’s criminal offense;
(6) The type of service the person is hired to
provide;
(7) The provider agency’s name and address;
(8) A full explanation of why the provider agency
is hiring the person despite the person’s criminal record;
(9) Signature of the individual(s) or legal
guardian(s) indicating agreement with the employment and date signed;
(10) Signature of the staff person who obtained
the individual’s or guardian’s signature and date signed;
(11) Signature of the area agency’s executive
director or designee approving the employment; and
(12) The signature and phone number of the person
being hired.
(g)
Provider agencies shall provide initial and ongoing training as required
in He-M 506 and as required to implement services in He-M 518.05 and He-M
518.07.
(h) Employment professionals shall:
(1) Meet one of the following criteria:
a. Have completed, or complete within the first
6 months of becoming an employment professional, training that meets the
national competencies for job development and job coaching, as established by
the Association of People Supporting Employment First (APSE) in “APSE Supported Employment
Competencies” (Revision 2010), available as noted in Appendix A; or
b. Have obtained the designation as a Certified
Employment Services Professional through the Employment Services Professional
Certification Commission (ESPCC), an affiliate of APSE; and
(2) Obtain 12 hours of continuing education
annually in subject areas pertinent to employment professionals including, at a
minimum:
a. Employment;
b. Customized employment;
c. Task analysis/systematic instruction;
d. Marketing and job development;
e. Discovery;
f. Person-centered employment planning;
g. Work incentives for individuals and
employers;
h. Job accommodations;
i. Assistive technology;
j. Vocational evaluation;
k. Personal career profile
development;
l. Situational assessments;
m. Writing meaningful
vocational objectives;
n. Writing effective
resumes and cover letters;
o. Understanding workplace
culture;
p. Job carving;
q. Understanding laws,
rules, and regulations;
r. Developing effective on
the job training and supports;
s. Developing a fading plan
and natural supports;
t. Self-employment; and
u. School to work
transition.
(i)
At a minimum, job coaching staff shall be trained on all of the
following prior to supporting an individual in employment:
(1) Understanding and respecting the business
culture and business needs;
(2) Task analysis;
(3) Systematic instruction;
(4) How to build natural supports;
(5) Implementation of the fading plan;
(6) Effective communication with all involved;
and
(7) Methods to maximize the independence of the
individual on the job site.
(j)
Supervisors of employment professionals shall ensure employment
professionals and job coaches meet the criteria outlined in (h) and (i) above.
Source. #10493, eff 2-18-14 (from He-M 518.08)
He-M 518.11 Oversight and Quality Improvement.
(a)
The director of employment services shall:
(1) Be responsible for providing oversight; and
(2) Evaluate, facilitate, and improve the quality
of services being delivered and outcomes achieved.
(b)
Each individual’s service coordinator shall provide oversight regarding
the employment service arrangement and review and facilitate the effectiveness
of the employment services being provided and outcomes achieved.
(c)
In fulfilling the responsibilities cited in (a) and (b) above, the
director of employment services and service coordinator shall consider whether
the following criteria are being met:
(1) Services are customized and meet the
interests, goals, and desired outcomes of the individual, as defined in the
service agreement;
(2) Goals reflect the individual’s growth and evolving
interests and are revised accordingly;
(3) The goals and desired outcomes identified in
the service agreement are being achieved;
(4) Staff are knowledgeable of the individual’s
service agreement as it pertains to employment services and are assisting in
meeting the desired goals and outcomes;
(5) Services occur in integrated settings;
(6) Methods or strategies for achieving the
individual’s employment services goals and desired outcomes are evident and
documented; and
(7) Individuals, and guardians if applicable, are
satisfied with services.
(d)
The bureau shall develop and maintain an employment services leadership
committee consisting of representation of employment professionals from area
agencies, provider agencies, and the bureau of vocational rehabilitation.
(e)
The employment services leadership committee shall:
(1) Review quarterly employment data reports,
identify trends, and establish statewide employment benchmarks;
(2) Identify and ensure relevant employment
training is available for individuals served, families, employment professionals,
service coordinators and other agency personnel;
(3) Annually review the memorandum of
understanding between the bureau of developmental services and the bureau of
vocational rehabilitation;
(4) Provide an annual report to the developmental
services quality council, established pursuant to RSA 171-A:33, at the end of
each fiscal year;
(5) Review national core indicators and other
relevant data to measure individual and family satisfaction with employment
services; and
(6) Support efforts to collaborate with business
and industry.
Source. #10493, eff 2-18-14
He-M 518.12 Waivers.
(a) An applicant,
area agency, provider agency, individual, guardian, or provider may request a
waiver of specific procedures outlined in He-M 518 using the form titled “NH
bureau of developmental services waiver request” (September 2013 edition). The area agency
shall submit the request in writing to the bureau administrator.
(b) A completed waiver
request form shall be signed by:
(1) The individual or guardian indicating
agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c) A waiver request shall be submitted to:
Office of Client
and Legal Services
Hugh J. Gallen
State Office Park
105 Pleasant
Street, Main Building
Concord, NH 03301
(d)
No provision or procedure prescribed by statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner or his or
her designee within 30 days if the alternative proposed by the requesting
entity meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not affect the quality of services to
individuals.
(f)
Upon receipt of approval of a waiver request, the requesting entity’s
subsequent compliance with the alternative provisions or procedures approved in
the waiver shall be considered compliance with the rule for which waiver was
sought.
(g)
Waivers shall be granted in writing for a specific duration not to
exceed 5 years except as in (h) and (j) below.
(h)
Those waivers which relate to other issues relative to the health, safety
or welfare of individuals that require periodic reassessment shall be effective
for the current certification period only.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
A requesting entity may request a renewal of a waiver from the
bureau. Such request shall be made at
least 90 days prior to the expiration of a current waiver.
Source. #10493, eff 2-18-14 (from He-M 518.09)
PART He-M 519 FAMILY SUPPORT SERVICES
He-M 519.01 Purpose. The purpose of this part is:
(a)
To establish a framework for the provision of supports and services to
care-giving families with an individual member who:
(1) Has a developmental disability or acquired
brain disorder; or
(2) Is eligible for family-centered early supports
and services pursuant to He-M 510.06;
(b)
To describe the structure, roles, and responsibilities of regional
family support councils in advising and collaborating with their local area
agencies; and
(c) To describe the structure, roles,
and responsibilities of the state family support council in supporting regional
councils and in advising the bureau.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff 2-26-11; ss by #12784, eff
5-21-19
He-M 519.02 Definitions.
(a)
“Acquired brain disorder” means a disruption in brain functioning that:
(1) Is not congenital or caused by birth trauma;
(2) Presents a
severe and life-long disabling condition which significantly impairs a person’s
ability to function in society;
(3) Occurs prior to age 60;
(4) Is attributable to one or more of the
following reasons:
a. External trauma to the brain as a result of:
1. A motor vehicle incident;
2. A fall;
3. An assault; or
4. Another related traumatic incident or
occurrence;
b. Anoxic or hypoxic injury to the brain such as
from:
1. Cardiopulmonary arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases such as encephalitis and
meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; or
h. Other neurologic disorders such as Huntington’s
disease or multiple sclerosis which predominantly affect the central nervous system;
and
(5) Is manifested by:
a. Significant decline in cognitive functioning and
ability; or
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits.
(b)
“Area agency” means “area agency” as defined in RSA 171-A:2, I-b.
(c)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(d)
“Bureau administrator” means the chief administrator of the bureau of
developmental services.
(e)
“Commissioner” means the commissioner of the department of health and
human services.
(f)
“Department” means the New Hampshire department of health and human
services.
(g)
“Developmental disability” means “developmental disability” as defined
in RSA 171:A:2, V, namely “a disability:
(a) Which is attributable to intellectual
disability, cerebral palsy, epilepsy, autism, or a specific learning disability,
or any other condition of an individual found to be closely related to
intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability; and
(b) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual’s ability to function
normally in society.”
(h)
“Family” means a group of 2 or more persons that:
(1) Is related by ancestry, marriage, or other
legal arrangement;
(2) Has one member who is the primary caregiver of
the individual in (3) below; ; and
(3) Has at least one member who is an individual
as defined in (j) below.
(i)
“Family support” means those services, activities, and interventions,
enumerated in He-M 519.04 (c), that are identified by a family to assist that
family to remain the primary caregiver of an individual.
(j) “Individual” means a person with a
developmental disability or acquired brain disorder who is eligible or
conditionally eligible pursuant to He-M 503.03 or He-M 522.03 or a child,
through age 2, who is eligible for family-centered early supports and services
pursuant to He-M 510.06.
(k)
“Partners in Health (PIH)” means “partners in health” as defined in He-M
523, namely “a New Hampshire
community-based program of family support for young adults and families”.
(l)
“Region” means “area” as defined in RSA 171-A:2, I-a, namely “a
geographic region established by rules adopted by the commissioner for the purpose
of providing services to developmentally disabled persons”.
(m)
“Respite” means the provision of short-term care, in accordance with
He-M 513, for an individual, in or out of
the individual’s home, for the temporary relief and support of the family with
whom the individual lives.
(n)
“Special medical services (SMS)” means “special medical services” as
defined in He-M 520 namely, “the administrative section of the bureau of
developmental services that operates the
Title V program for children and youth with special health care needs”.
(o)
“Supports and services” means a wide range of activities that assist
families in developing and maximizing the families’ abilities to care for
individuals and meet their needs in a flexible manner.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff 2-26-11; ss by #12784, eff
5-21-19
He-M 519.03 Eligibility. A family shall be eligible for family support
services if such family has:
(a)
An individual member from birth through age 2 who is eligible for
family-centered early supports and services pursuant to He-M 510.06; or
(b)
An individual member age 3 or older who has a developmental disability
or an acquired brain disorder pursuant to He-M 503.03 or He-M 522.03.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff
2-26-11; ss by #12784, eff 5-21-19
He-M 519.04 Supports and Services.
(a)
Family support services shall:
(1) Focus on the entire family;
(2) Recognize and value the family’s strengths
and competencies;
(3) Respect the
family’s approach to making decisions regarding provision of supports and
services;
(4) Create and emphasize opportunities for
families to build relationships in their communities;
(5) Maximize the family’s control over the
provision of supports and services;
(6) Identify
resources and supports and services that are flexible, individualized, and responsive
to the changing needs of the family;
(7) Respect the family’s cultural and ethnic
beliefs, traditions, personal values, and lifestyles;
(8) Empower
families through educational opportunities and wide dissemination of information;
and
(9) Promote family involvement in all levels of
planning, policy-making, and monitoring of the service system.
(b)
In addition to offering area agency programs or funds to provide
supports and services, family support staff shall explore, identify, and assist
families to access community resources, both formal and informal, as available.
(c)
Family support shall include the following:
(1) Information and referral;
(2) Assistance to identify and assess the
family’s own strengths, needs, and goals;
(3) Identification of, and assistance to access,
community resources and supports;
(4) Assistance with transition in and out of
services;
(5) Crisis intervention and emotional support;
(6) Advocacy for accessing supports and services;
(7) Opportunities for family networking;
(8) Assistance to access respite care;
(9) Assistance to access environmental
modifications of the family’s home and the family’s vehicle;
(10) Promotion of inclusive social and
recreational opportunities;
(11) Conferences and workshops in response to families’
requests;
(12) Community outreach, education, and
development to promote understanding and support for families as well as individuals
with disabilities;
(13) Financial
assistance provided that this assistance is:
a. Related to supporting a family to care for an
individual member in the family home; and
b. Consistent
with the established policies of the area agency and, if applicable, the
regional family support council as required by He-M 519.05(c)(5); and
(14) Other supports and services that assist a
family in providing care for an individual member in the family home.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff 2-26-11;
ss by #12784, eff 5-21-19
He-M 519.05 Regional Family Support Council.
(a)
Each region shall have a family support council that shall act as an
advisory body to the area agency.
(b)
A regional family support council shall:
(1) Be composed of a minimum of 5 voting members;
(2) Have members who are either family members or
individuals;
(3) Have no voting member who is an employee of
either the area agency or the family support council; and
(4) Have membership that is representative of the
various ages, and geographical locations, and overall diversity of the
individuals and families served in the region.
(c)
Regional family support councils shall establish and maintain policies
that address, at a minimum, the following:
(1) Membership, recruitment, rotation, and term
limits on the council;
(2) A process for determining the chairperson,
the state council delegate, the council representative to the area agency board
of directors, and any other positions;
(3) Orientation and mentoring of all council
members;
(4) A formal written agreement between the
council and the area agency that identifies:
a. The parties’ relationship, roles, and
responsibilities;
b. The process to be used in resolving any
conflicts which might arise between the parties;
c. The involvement of the council in the
selection and evaluation of the performance of the family support staff;
d. The family
support representative on the area agency management team and the mechanism for
direct communication between this person and the council;
e. The family
support council’s obligation to comply with all confidentiality requirements as
set by federal authorities, the department, or the area agency; and
f. The process for sharing contact information
for families in the region with the family support council for the purpose of
outreach, advocacy, or information.
(5) Processes used to distribute family support
council funds and other resources, and the processes shall include ensuring
family privacy in the application and fund allocation process; and
(6) A mechanism for the council to be involved in
the area agency monitoring of supports and services provided to families.
(d)
The regional family support councils shall coordinate their efforts with
other local public and private entities that serve children, adults, and
families, including but not limited to early supports and services providers,
PIH, and SMS.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff
2-26-11; ss by #12784, eff 5-21-19
He-M 519.06 Family Support Staff.
(a) Each area agency shall designate
not less than one full-time position as the family support coordinator or
director.
(b) The qualifications and duties of the staff
person designated pursuant to (a) above shall be identified by a job
description designed jointly by the regional family support council and the
area agency.
(c)
The designated staff person shall perform all duties in his or her job
description including, at a minimum:
(1) Representing the ideas and concerns of
families and of family support staff to the area agency executive director and
at management team meetings;
(2) Promoting the values of family support as
listed in He-M 519.04 (a) in area agency activities and initiatives;
(3) Acting as the primary liaison with the
council and regularly attending council meetings;
(4) Providing information to the council regarding
family support activities so that the council:
a. Understands families’ needs;
b. Can act on families’ needs; and
c. Is involved in the area agency monitoring of
regional supports and services;
(5) Ensuring that
an individual or family has accessed all other available funding and community
resources prior to requesting funding for family supports from the council;
(6) Facilitating the distribution of family
support funds approved for distribution by the family support council;
(7) Providing information or referral to PIH if
requested by the PIH family support coordinator, or the individual, or family;
and
(8) Providing feedback to other family support
staff from the council and the management team.
(d)
Family support staff shall:
(1) Provide, or assist families in accessing,
family supports and services;
(2) Solicit support
for families from community groups, foundations, and other sources as needed;
(3) Plan and develop agreements with each family
that document the supports in He-M 519.04 (c) that will be provided;
(4) Maintain records regarding the supports and
services provided to each individual or family;
(5) Maintain data that specifies the type and frequency
of family supports and services provided; and
(6) Report data collected pursuant to (4) and (5)
above to the bureau on a quarterly basis.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff 2-26-11; ss by #12784, eff
5-21-19
He-M 519.07 Regional Family Support Plan.
(a)
Each regional family support council shall contribute to the development
of the area plan prepared pursuant to He-M 505.03 (t)-(u).
(b) To satisfy the requirements of
He-M 505.03 (u)(2), the regional family support council’s contribution pursuant
to (a) above shall consider:
(1) The priorities of families residing throughout
the region for supports and services; and
(2) Strategies to address these priorities.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff
2-26-11; ss by #12784, eff 5-21-19
He-M 519.08 State Family Support Council. The state family support council shall:
(a)
Be comprised of one voting delegate appointed by each of the 10 regional
family support councils;
(b)
Be assisted by the family support administrator or designee and bureau
support staff;
(c)
Elect a new chairperson at least every 2 years;
(d)
Hold meetings every other month to discuss agenda items formulated by
members of the council;
(e)
Be a forum for exchanging, sharing, and distributing information to each
regional council;
(f) Be an avenue for arbitration and
mediation of conflict resolution between area agencies and regional councils
when requested by both parties and after processes identified pursuant to He-M
519.05(c)(4)b. have been exhausted; and
(g)
Provide information and feedback on issues and concerns of regional
councils to the bureau.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff 2-26-11; ss by #12784, eff
5-21-19
(a) An area agency or regional family support council
may request a waiver of specific procedures outlined in He-M 519 by completing
and submitting to the department the form entitled “NH Bureau of Developmental
Services Waiver Request” (January 2018 edition).
(b) A completed waiver request form shall include
signatures by the family support council chairperson or designee indicating
agreement with the request and the area agency’s executive director or designee
recommending approval of the waiver.
(c) A waiver request shall be submitted to:
Department of Health and Human Services
Bureau of Developmental Services
Hugh J. Gallen State Office Park
105 Pleasant Street, Main Building
Concord, NH 03301
(d)
All information entered on the forms described in (a) above shall be
typewritten or otherwise legibly written.
(e) No provision or procedure prescribed by statute
shall be waived.
(f) The request for a waiver shall be granted by
the commissioner or his or her designee within 30 days if the alternative
proposed by the requesting entity meets the objective or intent of the rule and
it:
(1) Does not
negatively impact the health or safety of the individual(s); and
(2) Does not
affect the quality of services to individuals.
(g) Upon receipt of approval of a waiver request,
the requesting entity’s subsequent compliance with the alternative provisions
or procedures approved in the waiver shall be considered compliance with the
rule for which waiver was sought.
(h) Waivers shall be granted in writing for a
specific duration not to exceed 5 years except as in (i) below.
(i) A requesting entity may request a renewal of
a waiver from the bureau. Such request
shall be made at least 90 days prior to the expiration of a current waiver.
(j) A request for renewal of a waiver shall be
approved in accordance with the criteria specified in (f) above.
Source. #5929, eff 12-1-94, EXPIRED: 12-1-00
New. #7830, eff 2-13-03, EXPIRED: 2-13-11
New. #9879-A, eff 2-26-11, (paras (a) & (d)-(j));
#9879-B, eff 2-26-11, (paras (b)-(c));
ss by #12784, eff 5-21-19
PART He-M 520 CHILDREN’S SPECIAL MEDICAL SERVICES
Statutory
Authority: RSA 132:10-b, IV
PART He-M 520 CHILDREN’S SPECIAL MEDICAL SERVICES
Statutory
Authority: RSA 132:10-b, IV
REVISION NOTE:
Document #13370, effective 4-20-22, readopted
with amendments the form “Special Medical Services (SMS)—Application for All
Services” and re-named the form “Bureau for Family Centered Services (BFCS)—Application
for Services” pursuant to the expedited revisions to agency forms process in
RSA 541-A:19-c. Document
#13370 updated the revision date on the form from “(December 2018)” to “(4/2022)”. The form is incorporated by reference in He-M
520.02(a) and He-M 523.04(a)(1). Document
#13370 contained only the amended form, giving it a new effective date of
4-20-22. The prior
filing affecting rule He-M 520.02 was Document #12699, effective 12-28-18,
and the prior filing affecting rule He-M 523.04 was Document #12700, effective 12-28-18,
although the revision date for the form in the rules was “(August, 2018).” The effective date of the rules remained unchanged
by Document #13370.
Document #13696, effective 7-22-23, readopted
with amendments the form “Bureau for Family Centered Services (BFCS)—Application
for Services” pursuant to the expedited revisions to agency forms process in
RSA 541-A:19-c. Document #13696 updated
the revision date on the form from “(4/2022)” to “(July 2023)”. The form is still incorporated by reference
in He-M 520.02(a) and He-M 523.04(a)(1).
Document #13696 contained only the amended form, giving it a new
effective date of 7-22-23. Since Document #13696 updated the revision date
on the form from “(4/2022)” to “(July 2023)”, the revision date was subsequently
updated editorially in He-M 520.02(a) and He-M 523.04(a)(1) from “(August 2018)”
to “(July 2023)”. The effective date of
the rules remained unchanged by Document #13696.
He-M 520.01 Definitions.
(a)
“Administrator” means the person who oversees the bureau of special
medical services and its contractors.
(b)
“Allowable deduction” means the amount subtracted from a household’s
annual gross income, which represents expenses paid by a household member whose
income is counted when determining financial eligibility, and is limited to:
(1) Monthly court-ordered alimony payments;
(2) Monthly court-ordered child support payments;
(3) Monthly household child care expenses when
both parents are employed or when one parent is employed and the other parent
is functionally unable to care for the child;
(4) Monthly private health and or dental insurance
premiums;
(5) Monthly food deduction for a household member
with a specialty diet recommended by a licensed clinician, not to exceed $400
per month;
(6) Annual deduction of $1,000 for each additional
current recipient in the household, not to exceed $3,000 per household; and
(7) Annual single head of household deduction not
to exceed $1,000.
(c)
“Annual gross income” means the sum of all income received by the
household as listed below:
(1) Including, but not limited to:
a.
Wages, salaries, tips, and commissions before deductions;
b.
Net earnings or Schedule C income from self-employment, partnership, or
business;
c.
Net rental income;
d.
Dividends;
e.
Interest;
f.
Annuities;
g.
Pensions;
h.
Royalties;
i.
Government- or state-issued benefits, such as:
1. Public assistance;
2. State financial grants;
3. Social security benefits;
4. Unemployment compensation;
5. Workers compensation; and
6. Veterans Administration benefits;
j.
Alimony or child support received;
k.
One-time insurance payments or compensation for injury or death
received;
l.
Medical settlements, and
m.
Non-medical trusts established for the applicant or any household
member; and
(2) Excluding income from sale of property, tax
refunds, gifts, scholarships, trainings, or stipends.
(d)
“Applicant” means the person for whom the application is made and who,
if determined to be eligible, becomes the recipient.
(e)
“Bureau” means the bureau of
special medical services within the department of health and human
services.
(f) “Children with special health care needs”
means “children with special health care needs” as defined in RSA 132:13, II,
namely “children who have or are at risk for chronic physical, developmental,
behavioral, or emotional conditions and who also require health and related
services of a type or amount beyond that required by children generally.”
(g)
“Chronic medical condition” means an ongoing physical, developmental,
behavioral, or emotional illness or disability, which:
(1) Is expected to last one year or longer;
(2) Requires extended sequential, medical,
surgical, or rehabilitative intervention as determined by a diagnostic
evaluation performed by a licensed clinician who is board eligible or board
certified;
(3) Is one of the following:
a.
Genetic condition;
b.
Inborn error of metabolism;
c.
Pulmonary or respiratory condition;
d. Genitourinary disorder;
e.
Musculoskeletal condition;
f.
Blindness as defined by 42 USC 416 (i)(1);
g. Deafness as defined by 34 CFR 300.7 (c)(3);
h.
Congenital anomaly;
i.
Developmental delay from birth to 6 years of age;
j.
Limb deficiency, including post amputation;
k.
Cranial facial anomaly;
l.
Neurologic condition;
m.
Digestive system condition;
n.
Endocrine abnormality, excluding conditions noted in (4) b. below;
o.
Cardiovascular condition;
p.
Neuromotor disorder;
q.
Spinal cord injury;
r.
Hematological disorder;
s.
Immunological disorder;
t.
Malignant neoplastic disease; or
u.
Skin disorder as listed in 20 CFR 404, Subpart P, Appendix 1; and
(4) Is not one of the following:
a.
An acute or recurrent condition encompassing the area of routine medical
care;
b.
A hormonal condition for which long-term replacement therapy is required,
such as short stature; and
c.
A dental or orthodontic condition except as related to conditions in
(3)h. or (3)k. above.
(h)
“Date of application” means the date stamped on the SMS application as
indication that the application was received by SMS.
(i)
“Department” means the New Hampshire department of health and human
services.
(j)
“Durable medical equipment” means a non-disposable device that:
(1) Can withstand repeated use;
(2) Is appropriate for in-home use for the
treatment of an acute or chronic medically diagnosed health condition, illness,
or injury; and
(3) Is not useful to a person in the absence of
an acute or chronic medically diagnosed health condition, illness, or injury.
(k)
“Federal poverty guidelines” means the annual revision of the poverty
income guidelines for the United States Department of Health and Human Services
as published in the Federal Register (74 FR 4199).
(l)
“Financial assistance” means a payment made by SMS in whole or in part
for health-related services.
(m)
“Health-related service” means a service related to the treatment of a
recipient’s chronic medical condition, such as, but not limited to:
(1) Therapies;
(2) Medications;
(3) Hospitalizations; and
(4) Durable medical equipment or medical supplies.
(n)
“Household” means one or more children under the age of 21 and the
adults who are directly related to them by blood, by marriage, or by adoption
or who assist in the personal care and rearing of an applicant, all of whom reside
in the same home.
(o)
“Household income” means the annual gross income of the applicant and
the adults included in the household.
(p)
“Medicaid” means the Title XIX and Title XXI programs administered by
the department that makes medical assistance available to eligible individuals.
(q)
“Medical liability” means a household’s accrued medically related debt
or medical expenses paid within the past 12 months that are not covered by
third party liability insurance (TPL), including, but not limited to:
(1) Office visit or prescription co-payments;
(2) Emergency department visits;
(3) Insurance or COBRA payments;
(4) TPL required deductibles; and
(5) Other non-covered medical services.
(r)
“Medically necessary” means health care services and items that a
licensed health care provider, exercising prudent clinical judgment, would
provide, in accordance with generally accepted standards of medical practice,
to a recipient for the purpose of evaluating, diagnosing, preventing, or
treating an acute or chronic illness, injury, disease, or its symptoms, and
that are:
(1) Clinically appropriate in terms of type,
frequency of use, extent, site, and duration;
(2) Consistent with the established diagnosis or
treatment of the recipient’s illness, injury, disease, or its symptoms;
(3) Not primarily
for the convenience of the recipient or the recipient’s family, caregiver, or
health care provider;
(4) Not costlier
than other items or services which would produce equivalent diagnostic,
therapeutic, or treatment results as related to the recipient’s illness, injury,
disease, or its symptoms;
(5) Not
experimental, investigative, cosmetic, or considered alternative by current
medical practices;
(6) Not duplicative in nature; and
(7) Proven to be safe and effective, as
documented in medical peer review literature.
(s)
“Medical supplies” means consumable or disposable items appropriate for
in-home use for relief or treatment of a specific medically diagnosed health
condition, illness, or injury.
(t)
“Net income” means the household’s annual gross income minus any
allowable deductions, defined in (b) above.
(u)
“Provider” means an individual who provides a medical, therapeutic, or
other direct care service within his or her office, agency, practice, or during
a home visit.
(v)
“Recipient” means a child with special health care needs who has met the
established criteria as described in He-M 520.02.
(w) “Resource(s)” means any funds, available to
the household, with the exception of Achieving a Better Life Experience (ABLE)
Act/STABLE accounts, minus any penalties for withdrawal, including, but not
limited to:
(1) Checking accounts;
(2) Savings accounts;
(3) Certificates of deposit;
(4) Investments, such as mutual funds, stocks,
and bonds; and
(5) Trust funds.
(x)
“Special medical services (SMS)” means the bureau of special medical
services that operates the Title V program for children and youth with special
health care needs.
(y)
“Spend down” means the amount of a household’s net income which exceeds 185% of
that household’s federal poverty guideline amount.
(z)
“Third party” means any private insurer, health maintenance organization,
hospital service organization, medical service or health services corporation,
governmental agency, or any individual, organization, entity, or agency which
is authorized or under legal obligation to pay for medical services for a
recipient.
(aa) “Title V” means the program described in
Title V of the Social Security Act. SMS
administers the NH children with special health care needs component of Title V
as part of the Health Resources and Services Administration, United States
Department of Health and Human Services.
(ab)
“Title XIX” means the joint federal-state program described in Title XIX
of the Social Security Act and administered in New Hampshire by the department
under the Medicaid program.
(ac)
“Title XXI” means the joint federal-state program described in Title XXI
of the Social Security Act and administered in New Hampshire by the department under
the Medicaid program.
Source. #9748-A, eff 7-1-10; amd by #10138, eff 7-1-12;
ss by #12558, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12699, eff 12-28-18
He-M 520.02 Application Procedure.
(a)
In order to be determined eligible to receive program services or
financial assistance, a signed, dated, and completed application, entitled “Bureau
for Family Centered Services (BFCS),” (July 2023) shall be submitted to SMS for
each applicant.
(b)
The following documentation shall accompany the submitted application in
(a) above:
(1) Supporting documentation of income and
resources, as applicable;
(2) Supporting documentation regarding the
applicant’s health diagnosis;
(3) A signed
release of personal health information, which complies with current Health
Insurance Portability and Accountability Act (HIPPA) policies as defined in 45 CFR
160.103 and 45 CFR 164.501; and
(4) Documentation of guardianship of an applicant
or foster parent status, as applicable.
(c)
Within 60 days of the date of application, SMS shall:
(1) Accept and review all applications for
program or financial eligibility, in accordance with He-M 520.03 and He-M
520.05;
(2) Notify the applicant in writing of the
applicant’s eligibility status and the services for which the applicant is
eligible; and
(3) Have the
applicable Program Coordinator(s) initiate phone contact to discuss the SMS
program(s) for which the applicant has been found eligible.
(d)
SMS’s notice of decision shall include:
(1) For eligibility approvals:
a. The beginning and ending dates of SMS
eligibility;
b. The approved SMS services;
c. The name and phone number of an SMS contact
person;
d. Financial eligibility determination, including
the spend down amount, as applicable; and
e. Notice that the
recipient shall report to SMS any change in the recipient’s medical insurance coverage,
including Medicaid or TPL changes, within 30 days of the change; and
(2) For eligibility denials:
a. The reason(s) for denial;
b. Information about the applicant’s right to an
appeal in accordance with He-M 202 and He-C 200; and
c. Alternate support services information as
available.
(e)
For an applicant who is determined to be eligible, eligibility shall be
effective for 12 months from the applicant’s application date, except when any
household changes affect the recipient’s eligibility status.
(f)
SMS shall notify a recipient in writing 30 calendar days prior to the
date that eligibility will close, for such reasons as the 12-month eligibility
period is expiring, the recipient is turning 21, services provided are no
longer available, or there is a household change which affects eligibility
status.
(g)
A new application shall be submitted in accordance with (a) and (b)
above prior to the expiration of current eligibility.
(h)
An applicant or recipient shall have the right to reapply at any time
after eligibility has been denied.
(i)
An applicant who submits false or misleading information shall be
subject to the provisions of RSA 132:15 and RSA 638:15.
Source. #9748-A, eff 7-1-10, para (c)-(h), intro.,
& (i)(1), (4), & (5), and (j); #9748-B,
eff 7-1-10, paras (a), (b), and
(i)(3); amd by #10138, eff 7-1-12; ss by #12558, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New. #12699, eff 12-28-18; (see also Revision Note
at part heading for He-M 520)
He-M 520.03 Program Eligibility Requirements. To be eligible for services provided under
He-M 520.04, an applicant shall:
(a)
Be a child with special health care needs;
(b)
Be a resident of the State of New Hampshire and not have residency in
another state;
(c)
Be, or have a parent or guardian who is, a United States citizen or a
legal resident alien; and
(d)
Be under the age of 21.
Source. #9748-A, eff 7-1-10, para (c)-(h), intro.,
& (i)(1), (4), & (5), and (j); #9748-B,
eff 7-1-10, paras (a), (b), and
(i)(3); amd by #10138, eff 7-1-12; ss by #12558, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New. #12699, eff 12-28-18; (see also Revision Note
at part heading for He-M 520)
He-M 520.04 Services Provided.
(a)
Services provided to recipients by SMS or agencies under current service
contract obligation with SMS shall include:
(1) SMS care coordination services to:
a.
Assist the household in developing and implementing a health care plan
for the recipient; and
b.
Provide information about available types of third-party assistance;
(2) SMS nutrition services;
(3) SMS feeding and swallowing services;
(4) SMS consultation services;
(5) SMS specialty
services provided through attendance at child development clinics sponsored by
SMS;
(6) SMS specialty services provided through
attendance at complex care clinics sponsored by SMS; and
(7) SMS specialty services provided through
attendance at neuromotor clinics sponsored by SMS.
(b)
A recipient shall be limited to the services listed in (a)(4)-(6) above
if his or her primary diagnosis is one of the following:
(1) Attention deficit disorder;
(2) Autism spectrum disorder; or
(3) Another emotional or behavioral disorder.
Source. #9748-A, eff 7-1-10; ss by #12558, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New.
#12699, eff 12-28-18
He-M 520.05 Financial Eligibility Requirements.
(a)
To be eligible for financial assistance, a recipient shall:
(1) Meet the program eligibility requirements in
He-M 520.03;
(2) Have a documented chronic medical condition;
and
(3) Meet the financial eligibility requirements
in (b) through (h) below.
(b)
A recipient shall be eligible for financial assistance for health-related
services related to the recipient’s chronic medical condition if:
(1) The recipient resides in a household with a
net income less than or equal to 185% of that household’s federal poverty
guideline amount and with resources of $10,000 or less; or
(2) The recipient resides in a household with a
net income greater than 185% of that household’s federal poverty guideline amount
and the household’s medical liability is enough to reduce the household’s spend
down amount by 100% prior to receiving financial assistance.
(c)
The following shall apply to a household’s medical liability and spend
down amount:
(1) SMS shall determine a household’s medical
liability, each time eligibility for financial assistance is reviewed;
(2) A household’s medical liability shall be used
to reduce the spend down amount;
(3) A household’s medical liability that is used
to reduce the spend down amount in one year shall not be used to reduce the
spend down amount in any subsequent year;
(4) Medical liability used to reduce the spend down
amount shall not be eligible for payment through financial assistance; and
(5) SMS shall notify recipients in writing of
current spend down amounts.
(d)
If a household requests payment for services that would otherwise be
covered under Medicaid and the household’s income would allow it to be eligible
for Medicaid, the household shall be encouraged to apply for such Medicaid
services within 3 months of requesting financial assistance.
(e)
Households that do not apply for Medicaid eligibility for the applicant
pursuant to (d) above, shall not be eligible for financial assistance under
He-M 520.05 and He-M 520.06.
(f)
For purposes of determining financial eligibility, a recipient who meets
any of the following criteria shall be considered to be the only individual in
the household:
(1) The recipient is an emancipated minor;
(2) The recipient is aged 18 to 21;
(3) The recipient is a foster child; or
(4) The recipient has a court appointed guardian.
(g)
A recipient’s adult siblings who are 18 or older and share the
recipient’s residence shall be excluded as household members when the siblings:
(1) Are employed or have a source of income;
(2) Are married; or
(3) Have their own children.
(h)
For a child residing with a parent and one or more unrelated adult, the
income of the unrelated adult shall be included in the household income if the
unrelated adult is a parent of an applicant’s sibling.
(i)
When a household member reports to SMS and supplies supporting documentation
of a change in household net income, SMS shall then reassess financial
eligibility.
Source. #9748-A, eff 7-1-10; amd by #10138, eff
7-1-12; ss by #12558, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New.
#12699, eff 12-28-18
He-M 520.06 Payment for Health-Related Services.
(a)
SMS shall approve a recipient’s request for payment for a health-related
service when all the following are true:
(1) The recipient has been determined to be
financially eligible in accordance with He-W 520.05;
(2) The health-related service is:
a. Determined to be medically necessary;
b. Related to the recipient’s chronic medical
condition; and
c. Supported by the recipient’s SMS health care
plan;
(3) All third party resources, including the
recipient’s hospital, surgical, or medical insurance plans, have been
exhausted, except as allowed by (f) below; and
(4) A bill or invoice for a health-related
service is submitted to SMS:
a. Which is itemized and dated; and
b. For which the service date is:
1. Not more than 12 months prior to the
submission date;
2. Not prior to the recipient’s application
date; and
3. Not a date when the recipient was not
eligible for financial assistance.
(b)
Payments for health-related services shall be paid at the lowest of:
(1) The provider’s usual and customary charge to
the public, as defined in RSA 126-A:3, III(b);
(2) The lowest amount accepted from any other
third party payors; or
(3) The Medicaid rate established by the
department in accordance with RSA 161:4, VI(a).
(c)
Payment for hospital charges shall:
(1) Include both inpatient and outpatient
services; and
(2) Have a maximum of $3,000 per event.
(d)
Payment for diagnostic procedures shall have a maximum of $3,000 per
procedure.
(e)
Notwithstanding (b) above:
(1) Over-the-counter medication and
non-prescription medication items shall be paid as submitted if no current
Medicaid rate is available; and
(2) The administrator shall approve reimbursement
for health-related services over Medicaid rates when:
a. SMS has negotiated a higher payment rate(s)
with the provider; or
b. Medicaid reimbursement is less than what was
paid out of pocket by the recipient.
(f) The administrator shall approve reimbursement
for health-related services not submitted for Medicaid or third-party
reimbursement when:
(1) A Medicaid or TPL precedent has been set for
denial of equivalent services;
(2) A crisis situation exists that jeopardizes
the safety or health of the recipient; or
(3) The volume of service is over Medicaid or TPL
allowable limits.
(g)
With respect to Title XIX, Medicare, or any medical insurance program or
policy, SMS shall be the payor of last resort.
Nothing contained in these rules shall require SMS to provide payment
for medications, supplies, or services.
Source. #9748-A, eff 7-1-10; ss by #12558, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New.
#12699, eff 12-28-18
He-M 520.07 Limitation of Services. Financial assistance provided under these
rules shall be provided to the extent that funds for this purpose are
appropriated and made available to the bureau by the Legislature and not
otherwise reduced or restricted by legislative fiscal committee action.
Source. #9748-A, eff 7-1-10; ss by #12558, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New.
#12699, eff 12-28-18
He-M 520.08 Appeals.
(a)
Pursuant to He-M 202, an applicant, recipient, parent, or guardian may request
to informally resolve any disagreement with SMS, or, within 30 business days of
an SMS decision, she or he may choose to file a formal appeal. Any determination, action, or inaction by SMS
may be appealed.
(b)
If informal resolution is requested, the administrator shall meet and
review with the applicant, recipient, parent, or guardian the financial status
or medical condition of the applicant or recipient that pertains to the
applicant’s or recipient’s eligibility.
(c)
SMS shall notify the applicant, recipient, parent, or guardian of the
findings of the review, in writing, within 15 business days of a case review
conference.
(d) Formal appeals shall be submitted, in
writing, to the bureau administrator in care of the bureau’s office of client and
legal services. An exception shall be
that appeals may be filed verbally if the individual is unable to convey the
appeal in writing.
(e)
If a hearing is requested, the following actions shall occur:
(1) Services and payments shall be continued as a
consequence of a request for a hearing until a decision has been made; and
(2) If SMS’s decision is upheld, funding shall
cease 60 days from the date of the denial letter or 30 days from the hearing
decision, whichever is later.
Source. #9748-A, eff 7-1-10; ss by #12558, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New. #12699, eff 12-28-18
He-M 520.09 Waivers.
(a)
An applicant, parent, or guardian may request a waiver of specific
services as outlined in He-M 520 by completing and submitting to the
department, bureau of special medical services form titled “Department of
Health and Human Services, Bureau of Special Medical Services Waiver for
Services” ( December 2018)”.
(b)
A completed waiver request form shall be signed by the applicant,
parent, guardian, or provider indicating agreement with the request.
(c) The request for a waiver shall be granted by
the commissioner or his or her designee within 30 days if:
(1) The alternative proposed by the applicant, recipient,
parent, or guardian meets the objective or intent of the rule;
(2) The alternative proposed does not negatively impact
the health or safety of the household or recipient;
(3) The alternative proposed does not affect the
quality of services to a recipient; and
(4) All other TPL service requests have been exhausted
or denied.
(d)
A waiver request shall be submitted to:
Department of
Health and Human Services
Office of Special
Medical Services
State Office Park
South
129 Pleasant
Street, Thayer Building
Concord, NH 03301
(e)
No provision or procedure prescribed by statute shall be waived.
(f)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(g)
Waivers shall be granted in writing and remain in effect for the
duration of the recipient’s current eligibility.
(h)
Waivers shall end with the closure of the related program or service.
Source. #9748-A, eff 7-1-10; ss by #12558, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New.
#12699, eff 12-28-18
PART He-M 521 CERTIFICATION OF RESIDENTIAL SERVICES OR
COMBINED RESIDENTIAL AND COMMUNITY PARTICIPATION SERVICES PROVIDED IN THE
FAMILY HOME
Statutory
Authority: RSA 171-A:3; 18, IV; 137-K:3
He-M 521.01 Purpose. The purpose of these rules is to provide
minimum standards for residential services or combined community participation
and residential services for individuals with developmental disabilities or
acquired brain disorders who reside in their families’ homes. These rules shall not apply to individuals
who receive services under He-M 524, in-home supports.
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7227, INTERIM, eff 3-31-00, EXPIRED: 7-29-00
New. #7494, eff 5-22-01; ss by #9013, eff 10-27-07;
ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17
He-M 521.02 Definitions.
(a)
“Acquired brain disorder” means a disruption in brain functioning that:
(1) Is not congenital or caused by birth trauma;
(2) Presents a severe and life-long disabling
condition which significantly impairs a person’s ability to function in society;
(3) Occurs prior to age 60; and
(4) Is attributable to one or more of the
following reasons:
a. External trauma to the brain as a result of:
1. A motor vehicle incident;
2. A fall;
3. An assault; or
4. Another related traumatic incident or
occurrence;
b. Anoxic or hypoxic injury to the brain such as
from:
1. Cardiopulmonary arrest;
2. Carbon monoxide poisoning;
3. Airway obstruction;
4. Hemorrhage; or
5. Near drowning;
c. Infectious diseases, such as encephalitis and
meningitis;
d. Brain tumor;
e. Intracranial surgery;
f. Cerebrovascular disruption such as a stroke;
g. Toxic exposure; and
h. Other neurological disorders such as
Huntington’s disease or multiple sclerosis which predominantly affect the
central nervous system; and
(5) Is manifested by one or more of the
following:
a. Significant decline in cognitive functioning
and ability; or
b. Deterioration in:
1. Personality;
2. Impulse control;
3. Judgment;
4. Modulation of mood; or
5. Awareness of deficits.
(b)
“Area agency” means “area agency” as defined in RSA 171-A:2, I-b.
(c)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(d)
“Bureau administrator” means the chief administrator of the bureau of
developmental services.
(e)
“Commissioner” means the commissioner of the department of health and
human services or his or her designee.
(f)
“Community participation services” referred to elsewhere in He-M 500 and
He-M 1001 as “day services”, means habilitation, assistance, and instruction
provided to individuals that:
(1) Improve or maintain their performance of basic
living skills;
(2) Offer vocational and community activities, or
both;
(3) Enhance their social and personal development;
(4) Include consultation services, in response to
individuals’ needs, and as specified in service agreements, to improve or maintain
communication, mobility, and physical and psychological health; and
(5) At a minimum, meet the needs and achieve the
desired goals and outcomes of each individual as specified in the service
agreement.
(g)
“Department” means the New Hampshire department of health and human
services.
(h)
“Developmental disability” means “developmental disability” as defined
in RSA 171-A:2, V, namely, “a disability:
(a) Which is attributable to an intellectual
disability, cerebral palsy, epilepsy, autism or a specific learning disability,
or any other condition of an individual found to be closely related to an
intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability; and
(b) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual’s ability to function normally
in society.”
(i)
“Family” means a group of 2 or more persons related by ancestry,
marriage, or other legal arrangement that has at least one member who has a
developmental disability.
(j)
“Guardian” means a person appointed pursuant to RSA 464-A or a parent of
an individual under the age of 18 whose parental rights have not been
terminated or limited by law in such a way as to
remove the person’s right to make decisions pursuant to RSA 171-A on behalf of
the individual..
(k)
“Individual” means a person with a developmental disability or acquired
brain disorder who is eligible to receive services pursuant to He-M 503 or He-M
522.
(l)
“Provider” means a person receiving any form of remuneration for the
provision of services to an individual.
(m)
“Provider agency” means an area agency or another entity under contract
with an area agency to provide services.
(n)
“Representative” means:
(1) The parent or guardian of an individual under
the age of 18;
(2) The guardian of an individual 18 or over; or
(3) A person who has power of attorney for the
individual.
(o)
“Service” means any paid assistance to an individual in meeting his or
her own needs provided through the area agency.
(p)
“Service agreement” means a written agreement between an individual or
his or her guardian or representative and an area agency that is prepared in accordance with He-M 503 or He-M 522 and that describes the
services that an individual will receive and constitutes an individual service
agreement as defined in RSA 171-A:2,X.
(q)
“Service coordinator” means a person who is chosen or approved by an
individual and his or her guardian or representative to organize, facilitate
and document service planning and to negotiate and monitor the provision of the
individual’s services.
(r)
“Staff” means a person employed by an area agency or provider agency.
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7227, INTERIM, eff 3-31-00, EXPIRED: 7-29-00
New. #7494, eff 5-22-01; amd by #9013, eff
10-27-07; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17
He-M 521.03 Services.
(a)
All services shall be specifically tailored to the competencies,
interests, preferences, needs, and lifestyle of the individual served.
(b)
Services shall include assistance and instruction to improve and
maintain an individual’s skills in basic daily living, personal development,
and community activities, such as, but not limited to:
(1) Making personal choices;
(2) Promoting and maintaining safety;
(3) Enhancing communication;
(4) Participating in community activities;
(5) Developing and maintaining personal relationships;
(6) Finding and maintaining employment;
(7) Pursuing avocations in areas of personal
interest;
(8) Improving and maintaining social skills;
(9) Achieving and maintaining physical
well-being;
(10) Improving and/or maintaining mobility and
physical functioning;
(11) Shopping and managing money;
(12) Attending to personal hygiene and appearance;
(13) Doing household chores;
(14) Participating in meal preparation;
(15) Accessing and using assistive technology;
(16) Accessing and using transportation; and
(17) Other similar services as indicated in the
individual’s service agreement.
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7227, INTERIM, eff 3-31-00, EXPIRED: 7-29-00
New. #7494, eff 5-22-01; ss by #9475, eff 5-22-09;
ss by #12340, eff 7-25-17
He-M 521.04 Eligibility.
(a)
Any individual who resides at home with his or her family shall be
eligible for services identified in He-M 521.03, except as provided in (b) below.
(b)
An individual who resides in a foster home licensed by the division of
children, youth, and families shall not be eligible for services identified in
He-M 521.03.
Source. #5791, eff 3-1-94; ss by #6002, eff 4-1-95; ss
by #7494, eff 5-22-01; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17
He-M 521.05 Administrative Requirements.
(a)
Once a family expresses interest regarding He-M 521 services but before
services are provided under He-M 521, the area agency shall:
(1) Ensure that the proposed service arrangement:
a. Meets the individual’s expressed interests,
preferences, needs, and lifestyle;
b. Is consistent with the goals and services identified
in the individual’s service agreement; and
c. Meets the individual’s environmental and
personal safety needs; and
(2) Explain and discuss the following with the
individual, guardian, representative, and family members:
a. Area agency oversight of services provided
under He-M 521;
b. If applicable, the process of having staff or providers coming into
the home environment;
c. If the individual is taking medication, the supports available or needed to
administer the medication safely;
d. That modifications might be
necessary in the service agreement if and when the individual’s needs or
preferences change;
e. If applicable, receiving payments for the
provision of services;
f. If applicable, the relationship between the
area agency and the family member as a provider or subcontractor;
g. The requirements regarding certification of
services, including, for all people who are being considered for a position of
staff or provider:
1. Performing criminal background checks; and
2. Checking the state registry of abuse,
neglect, and exploitation reports as established by RSA 161-F:49; and
h. The conditions warranting the suspension or
revocation of certification.
(b)
In those situations where a family member is to be reimbursed as a
provider or subcontractor, the area agency or provider agency shall, in
consultation with the individual, guardian, representative, and family, develop
a contract that:
(1) Identifies the responsibilities of the area
agency, provider agency, if applicable, and the family member as a provider or
subcontractor;
(2) Describes the provision of supports needed to
administer medication safely;
(3)
Includes provision for time off and identifying the area agency or provider
agency responsibility in assisting the family to secure substitute providers
when the family member is the provider;
(4) Includes a provision for either party to dissolve
the contract with notice;
(5) Allows for review and revision as deemed
necessary by either party; and
(6) Is signed by all parties.
(c)
When services are being provided under He-M 521, the area agency shall:
(1) Have, at a minimum, quarterly contacts with
the family to provide information and support to ensure that services are provided
in accordance with the service agreement and He-M 521; and
(2) Ensure that the service arrangement is in
compliance with He-M 503.10 or He-M 522.
Source. #5791, eff 3-1-94; ss by #6002, eff 4-1-95;
ss by #7494, eff 5-22-01; amd by #9013, eff 10-27-07; ss by #9475, eff 5-22-09;
ss by #12340, eff 7-25-17
He-M 521.06 Medication Administration. When an individual living with his or her
family is in need of medication administration, such administration shall:
(a)
Comply with He-M 1201 when administered by area agency, provider agency staff, home providers, or other providers contracted
by the area agency;
(b)
Comply with Nur 404 when a nurse identified in Nur 404.04 delegates the
task of medication administration to providers who are neither family members
nor under contract with an area agency or provider agency, except in situations
where the individuals are living with their families and receiving respite
arranged by the family; or
(c)
When performed by family members paid under He-M 521, include discussion
between the area agency or provider agency and the family about any concerns
the family might have regarding medication administration.
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
New. #7494, eff 5-22-01; ss by #9475, eff 5-22-09;
ss by #12340, eff 7-25-17
He-M 521.07 Quality Assessment.
(a) An area agency shall monitor services provided
pursuant to He-M 521.
(b) All services shall be monitored by a service
coordinator, who:
(1) Meets the criteria in He-M 503.08 9(e)-(f);
(2) Is an area agency service coordinator, family
support coordinator or any other area agency or provider agency employee;
(3) Is a member of the individual’s family;
(4) Is a friend of the individual; or
(5) Another person chosen to represent the
individual.
(c)
On at least a monthly basis, the service coordinator shall visit or have
verbal contact with the individual or persons responsible for services to
review progress on achieving the goals in the service agreement, inquire about
other service needs, and document such visit or contact.
(d)
The service coordinator shall visit the individual at home and contact
the guardian or representative, if any, at least quarterly, or more frequently
if so specified in the individual’s service agreement, to determine and
document whether services:
(1) Match the interests, needs, preferences and lifestyle
of the individual;
(2) Meet with the individual’s satisfaction;
(3) Meet the individual’s environmental and
personal safety needs; and
(4) Meet the terms of the service agreement; and
(e)
If applicable, reviews of medication administration related activities
shall be conducted as required in He-M 1201.09(b) and (c).
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
New. #7494, eff 5-22-01; ss by #9475, eff 5-22-09;
ss by #12340, eff 7-25-17
He-M 521.08 Documentation. Individual records shall:
(a) Be maintained by the provider or staff; and
(b) Include:
(1) The service agreement;
(2) Provider or staff progress notes written at
least monthly, or more frequently if so specified in the service agreement,
including the dates services are provided and reports on progress toward achieving
desired outcomes;
(3) For community participation services, a
weekly personal schedule or calendar that:
a. Identifies the days, times, and locations of
the individual’s community activities such as recreation or paid or volunteer work;
or
b. Includes brief, daily notations that document
responses to people and activities and any changes in the individual's schedule;
and
(4) Any other documentation required by the area
agency.
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
New. #7494, eff 5-22-01; ss by #9013, eff 10-27-07;
ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17
He-M 521.09 Certification.
(a)
Residential services and combined residential and community
participation services provided under He-M 521 shall be certified by the
bureau.
(b)
To initiate the certification process, the area agency shall:
(1) Review the service arrangement and
documentation to confirm that all applicable requirements identified in He-M
521.05 and He-M 521.06 are being met; and
(2) At least 30 days prior to the start of services,
forward to the bureau:
a. The individual’s service agreement and
proposed budget; and
b. The area agency’s recommendation for certification.
(c)
To renew certification of services under He-M 521, the area agency
shall:
(1)
Review the service arrangement and documentation to confirm that all applicable
requirements identified in He-M 521.05 through He-M 521.08 are being met; and
(2) At least 30 days prior to the expiration of
the current services, forward to the bureau:
a. The individual’s service agreement and
budget; and
b. The area agency’s recommendation for
recertification.
(d)
Within 14 days of receiving the area agency recommendation pursuant to
(b) or (c) above, the bureau shall issue a certification if the applicable
requirements are being met.
(e)
All certifications granted by the bureau under (d) above shall be
effective for no more than 24 months.
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
New. #7494, eff 5-22-01; amd by #9013, eff
10-27-07; ss by #9475, eff 5-22-09; ss by #12340, eff 7-25-17
He-M 521.10 Denial and Revocation of Certification.
(a)
In the event of the denial or revocation of certification of services
pursuant to (c) below, the individual’s service coordinator shall assist him or
her to continue receiving alternative services that meet his or her needs.
(b)
The bureau shall deny an application for certification or revoke
certification of services, following written notice pursuant to (d) below and
opportunity for a hearing pursuant to He-C 200, due to:
(1) Failure of a staff member, provider, provider
agency, or area agency to comply with He-M 521 or any other applicable rule
adopted by the department;
(2) Hiring of persons below the age of 18 as
staff or providers;
(3) Submission of materially false or misleading
information to the department or failure to provide information requested by
the department and required pursuant to He-M 521;
(4) The staff, provider, provider agency, or area
agency preventing or interfering with any review or investigation by the
department;
(5) The staff, provider, provider agency, or area
agency failing to provide required documents to the department;
(6) Any reported abuse, neglect, or exploitation
of an individual by a provider, staff member, or person living in an
individual’s residence, if
a. Such abuse, neglect, or exploitation is
reported on the state registry of abuse, neglect, and exploitation in
accordance with RSA 161:F-49;
b. Such person(s) continues to have contact with
the individual; and
c. Such finding has not been overturned on
appeal, been annulled, or received a waiver pursuant to He-M 521.14;
(7) Failure by a provider agency or area agency
to perform criminal background checks on all persons paid to provide services under
He-M 521 who begin to provide such services on or after the effective date of
He-M 521, or any person living in an individual’s residence;
(8) A misdemeanor conviction of any staff or
provider or any person living in an individual’s residence that involves:
a. Physical or sexual assault;
b. Violence or exploitation;
c. Child pornography;
d. Threatening or reckless conduct;
e. Theft;
f. Driving under the influence of drugs or
alcohol; or
g. Any other conduct that represents evidence of
behavior that could endanger the well-being of an individual;
(9) A felony conviction of any staff or provider
or any person living in an individual’s residence; or
(10) Evidence that any provider or staff working
directly with individuals has an illness or behavior that, as evidenced by the
documentation obtained and the observations made by the department, would
endanger the well-being of the individuals or impair the ability of the provider
or staff to comply with department rules.
(c)
If the department determines that services meet any of the criteria for
denial or revocation listed in (b)(1)-(10) above, the department shall deny or
revoke the certification of the services.
(d)
Certification shall be denied or revoked upon the written notice by the
department to the family and provider, provider agency, or area agency stating
the specific rule(s) with which the service does not comply.
(e)
Any certificate holder aggrieved by the denial or revocation of the
certification may request an adjudicative proceeding in accordance with He-M
521.12 and the denial or revocation shall not become final until the period for
requesting an adjudicative proceeding has expired or, if the certificate holder
requests an adjudicative proceeding, until such time as the administrative appeals
unit issues a decision upholding the department’s action.
(f)
Pending compliance with all requirements for certification specified in
the written notice made pursuant to (d) above, a provider, provider agency, or
area agency shall not provide additional services if a notice of revocation has
been issued concerning a violation that presents potential danger to the health
or safety of the individuals being served.
Source. #5791, eff 3-1-94, EXPIRED: 3-1-00
New. #7242, INTERIM, eff 4-27-00, EXPIRED: 8-25-00
New. #7494, eff 5-22-01; ss by #9475, eff 5-22-09;
ss by #12340, eff 7-25-17
He-M 521.11 Immediate Suspension of Certification.
(a)
In the event that a violation poses an immediate and serious threat to
the health or safety of an individual, the bureau administrator shall suspend a
service’s certification immediately upon issuance of written notice specifying
the reasons for the action.
(b)
The bureau administrator or his or her designee shall schedule and hold
a hearing within 10 working days of the suspension for the purpose of
determining whether to revoke or reinstate the certification. The hearing shall provide opportunity for the
provider, provider agency, or area agency whose certification has been
suspended to demonstrate that it has been, or is, in compliance with the
specified requirements.
Source. #7494, eff 5-22-01; ss by #9475, eff 5-22-09;
ss by #12340, eff 7-25-17
He-M 521.12 Appeals.
(a)
Pursuant to He-C 200, an individual, guardian, or representative may
within 30 business days of the area agency decision, she or he may choose to
file a formal appeal. Any determination,
action, or inaction by an area agency may be appealed by an individual, guardian,
or representative.
(b)
An applicant for certification, provider, provider agency, or area agency
may request a hearing regarding a proposed revocation or denial of certification,
except as provided in He-M 521.11 above.
(c) Appeals shall be submitted, in writing, to the
bureau administrator in care of the department’s office of client and legal
services within 10 days following the date of the notification of denial or
revocation of certification. An
exception shall be that appeals may be filed verbally if the individual is unable
to convey the appeal in writing.
(d)
The bureau administrator shall immediately forward the appeal to the
department’s administrative appeals unit which shall assign a presiding officer
to conduct a hearing or independent review, as provided in He-C 200. The burden shall be as provided by He-C
203.14.
(e)
If a hearing is requested, the following actions shall occur:
(1) Services and payments shall be continued as a
consequence of an appeal for a hearing until a decision has been made; and
(2)
If the bureau’s decision is upheld,
funding shall cease 60 days from the date of the denial letter or 30 days from
the hearing decision, whichever is later.
Source. #7494, eff 5-22-01; ss by#9475, eff 5-22-09;
ss by #12340, eff 7-25-17
He-M 521.13 Payment.
(a)
In order to receive funding under He-M 521, services shall be certified
by the bureau in accordance with He-M 521.09.
(b)
Community‑based care providers shall submit claims for covered
community‑based care services on to:
Xerox Provider
Services
ATTN: Claims Administration
P.O. Box 2003
Concord, NH 03302-2003
(c)
Payment for community‑based care services shall only be made if
prior authorization has been obtained from the bureau.
(d)
Requests for prior authorization shall be made in writing to:
Xerox Provider
Services ATTN: Claims Administration
PO Box 2003
Concord, NH 03302-2003
(e)
For those individuals whose net income exceeds the appropriate standard
of need, Medicaid claims payment will reflect a reduction in reimbursement
equal to the cost of care amount..
(f)
In those situations where cost of care is subtracted from the Medicaid
billings, the area agency shall recover the cost from individuals unless they
qualify for Medicaid for employed adults with disabilities (MEAD) pursuant to
He-W 641.03.
(g) Payment for services shall not be available
to any service provider who:
(1) Is a person under age 18; or
(2) Is the spouse of an individual receiving
services.
Source. #9475, eff 5-22-09; ss by #12340, eff 7-25-17
He-M 521.14 Waivers.
(a)
An area agency, provider agency, individual, guardian, representative,
or provider may request a waiver of specific procedures outlined in He-M 521 by
completing and submitting the form titled “NH Bureau of Developmental Services
Waiver Request” (September 2013 edition).
The area agency shall submit the request in writing to the bureau
administrator.
(b)
A completed waiver request form shall be signed by:
(1) The individual, guardian(s), or
representative(s) indicating agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c)
A waiver request shall be submitted to:
Department of Health
and Human Services
Office of Client
and Legal Services
Hugh J. Gallen
State Office Park
105 Pleasant
Street, Main Building
Concord, NH 03301
(d)
No provision or procedure prescribed by statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner or his or
her designee within 30 days if the alternative proposed by the requesting
entity meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or safety
of the individual(s); and
(2) Does not affect the quality of services to individuals.
(f)
Upon receipt of approval of a waiver request, the requesting entity’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(g)
Waivers shall be granted in writing for a specific duration not to
exceed 5 years except as in (h) below.
(h)
Any waiver shall end with the closure of the related program or service.
(i)
A requesting entity may request a renewal of a waiver from the
bureau. Such request shall be made at
least 90 days prior to the expiration of a current waiver.
Source. #9475, eff 5-22-09 (from He-M 521.12); ss by
#12340, eff 7-25-17
PART He-M 522 ELIGIBILITY AND THE PROCESS OF
PROVIDING SERVICES FOR INDIVIDUALS
WITH AN ACQUIRED BRAIN DISORDER
Statutory Authority: RSA 137-K:3
He-M 522.01
Purpose. The purpose of
these rules is to establish standards and procedures for the determination of
eligibility, the development of service agreements, and the provision and
monitoring of services that
maximize the ability and informed decision-making authority of persons with acquired brain disorder,
and that promote the individual’s personal development, independence, and
quality of life in a manner that is determined by the individual.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18
He-M 522.02 Definitions.
(a)
“Acquired brain
disorder” means a disruption in brain functioning that:
(1) Is not
congenital or caused by birth trauma;
(2) Presents
a severe and life-long disabling condition which significantly impairs a person’s
ability to function in society;
(3) Occurs prior to age 60;
(4) Is
attributable to one or more of the following reasons:
a. External
trauma to the brain as a result of:
1. A motor
vehicle incident;
2. A fall;
3. An
assault; or
4. Another
related traumatic incident or occurrence;
b. Anoxic or
hypoxic injury to the brain such as from:
1.
Cardiopulmonary arrest;
2. Carbon
monoxide poisoning;
3. Airway
obstruction;
4. Hemorrhage;
or
5. Near
drowning;
c. Infectious
diseases such as encephalitis and meningitis;
d. Brain
tumor;
e. Intracranial
surgery;
f.
Cerebrovascular disruption such as a stroke;
g. Toxic
exposure; or
h. Other
neurological disorders, such as Huntington’s disease or multiple sclerosis, which
predominantly affect the central nervous system resulting in diminished
cognitive functioning and ability; and
(5) Is manifested by one or more of the following:
a.
Significant decline in cognitive functioning and ability; or
b.
Deterioration in:
1. Personality;
2. Impulse
control;
3. Judgment;
4. Modulation
of mood; or
5. Awareness
of deficits.
(b) “Advanced crisis funding” means revenue
authorized by the department of health and human services (department) when
funds are not otherwise available for an individual who is in crisis as
described in He-M 522.14(k) and requires services immediately.
(c) “Applicant” means any
person who requests services pursuant to He-M 522.04.
(d) “Area agency” means “area agency” as
defined in RSA 171-A:2, I-b.
(e) “Area agency director” means that person who
is appointed as executive director or acting executive director of an area
agency by the area agency’s board of directors.
(f)
“Assistive technology” means technology designed to be utilized in an
“assistive technology device” as defined in 29 U.S.C. section 3002(4) or
“assistive technology service” as defined in 29 U.S.C. section 3002(5).
(g) “Basic service agreement” means a
written agreement between the individual, guardian, or representative and the
area agency that is prepared pursuant to He-M 522.11 for each individual
receiving services and that outlines the services and supports to be provided.
(h)
“Brain Injury Community Supports” means services
administered through the Brain Injury Association of New Hampshire that:
(1) Are provided to persons
with an acquired brain disorder who are eligible for services pursuant to He-M
522.03 (a) but do not meet the eligibility criteria in He-M 517.03 (a) for
Medicaid home- and community-based care; and
(2) Include, at a minimum
the following services when such services are not reimbursable by Medicaid or
other insurance:
a. Home modification;
b. Respite service;
c. Assistive technology;
d. Specialized equipment;
e. Transportation;
f. Short-term financial
assistance, such as for utilities or rent;
g. Therapeutic evaluations;
and
h. Other similar limited or
nonrecurring services necessary for an individual to live as safely and
independently as possible in his or her community.
(i)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(j) “Bureau administrator”
means the chief administrator of the bureau of developmental services.
(k) “Commissioner” means the commissioner of the
department of health and human services or his or her designee.
(l) “Department” means the New
Hampshire department of health and human services.
(m) “Developmental
disability” means “developmental disability” as defined in RSA 171-A:2, V, namely,
a disability:
(1) “Which is attributable to an intellectual
disability, cerebral palsy, epilepsy, autism, or a specific learning disability,
or any other condition of an individual found to be closely related to an
intellectual disability as it refers to general intellectual functioning or
impairment in adaptive behavior or requires treatment similar to that required
for persons with an intellectual disability”; and
(2) “Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual’s ability to function
normally in society.”
(n)
“Direct and manage” means to be actively involved in all aspects of the
service arrangement, including:
(1) Designing the services;
(2) Selecting the service providers;
(3) Deciding how the authorized funding is to be
spent based on the needs identified in the individual’s service agreement; and
(4) Performing ongoing oversight of the services
provided.
(o)
“Expanded service agreement” means a written agreement between the individual,
guardian, or representative and the area agency that is prepared pursuant to
He-M 522.11 and describes services pursuant to He-M 1001, He-M 521, He-M 525,
He-M 507, and He-M 518.
(p) “Family support
coordinator” means an area agency staff member who provides assistance to
families in accordance with He-M 519.04.
(q) “Guardian” means a person appointed pursuant
to RSA 463, RSA 464-A, or a parent or guardian of an individual under
the age of 18 whose parental rights have not been terminated or limited by law
in such a way as to remove the parent or guardian’s right to make decisions
pursuant to RSA 171-A on behalf of the individual.
(r)
“Health Risk Screening Tool (HRST)” means the 2015 edition of the Health
Risk Screening tool, available as noted in Appendix A, which is a web-based
rating instrument used for performing health risk screenings on individuals in
order to:
(1) Determine an individual’s vulnerability regarding
potential health risks; and
(2) Enable the early identification of health
issues and monitoring of health needs.
(s)
“Home and community-based services” means medicaid services pursuant to
He-M 517.
(t) “Individual” means a person with an acquired brain disorder
who is eligible to receive services pursuant to He-M 522.03.
(u) "Informed consent" means a decision made voluntarily
by an individual or applicant for services or, where appropriate, such person's
legal guardian or representative, after all relevant information necessary to
making the choice has been provided, when the person understands that he or she
is free to choose or refuse any available alternative, when the person clearly
indicates or expresses his or her choice, and when the choice is free from all
coercion.
(v)
“Intellectual disability” means “intellectual disability” as defined in
RSA 171-A:2, XI-a, namely, “significantly sub-average general intellectual
functioning existing concurrently with deficits in adaptive behavior, and
manifested during the developmental period.
A person with an intellectual disability may be considered mentally ill
provided that no person with an intellectual disability shall be considered
mentally ill solely by virtue of his or her intellectual disability.”
(w)
“Local education agency (LEA)” means “local education
agency” as defined in 34 CFR 300.28 and Ed 1102.03 (o).
(x) “Medicaid home- and
community-based care services” means services provided in accordance to He-M
517.
(y) “Mental illness” means a condition of a
person who is or has been determined severely mentally disabled in accordance
with He-M 401.05 through He-M 401.07 and who has at least one of the following
psychiatric disorders classified in the Diagnostic and Statistical Manual of
Mental Disorders (Fifth Edition, Text Revision) (DSM-5), available as
listed in Appendix A :
(1) Schizophrenia spectrum and other psychotic
disorders, except for the following:
a. Schizotypal personality disorder;
b. Substance or medication induced psychotic
disorder; and
c. Psychotic disorder due to another medical
condition;
(2) Bipolar and related disorders, except for the
following:
a. Substance or medication induced bipolar and
related disorder; and
b. Bipolar disorder and related disorder due to
another medical condition;
(3) Depressive disorders, except for the
following:
a. Disruptive mood dysregulation disorder;
b. Premenstrual dysphoric disorder;
c. Substance or medication induced depressive
disorder; and
d. Depressive disorder due to another medical
condition;
(4) Borderline personality disorder;
(5) Panic disorder;
(6) Obsessive compulsive disorder;
(7) Post traumatic stress disorder;
(8) Bulimia nervosa;
(9) Anorexia nervosa;
(10) Other specific feeding or eating disorders;
(11) Unspecified feeding or eating disorders; and
(12) Major
neurocognitive disorders where psychiatric symptom clusters cause significant
functional impairment and one or more of the following symptom categories are
the focus of psychiatric treatment:
a. Anxiety;
b. Depression;
c. Delusions;
d. Hallucinations;
e. Paranoia; and
f. Behavioral disturbance.
(z)
“Participant directed and managed services” means services provided
pursuant to He-M 525 whereby the individual or representative, if applicable,
directs and manages the services, as defined in (n) above. Services include assistance and resources to
individuals in order to maintain or improve their skills and experiences in living,
working, socializing, and recreating.
(aa)
“Personal profile” means a narrative description that includes:
(1) A personal statement from the individual and those
who know him or her best that summarizes the individual’s strengths and
capacities, communication and learning style, challenges, needs, interests, and
any health concerns, as well as the individual’s hopes and dreams;
(2) A personal history covering significant life
events, relationships, living arrangements, health, and use of assistive
technology, and results of evaluations which contribute to an understanding of the
person’s needs;
(3) A review of the past year that:
a. Summarizes the individual’s:
1. Personal achievements;
2. Relationships;
3. Degree of community involvement;
4. Challenging issues or behavior;
5. Health status and any changes in health; and
6. Safety considerations during the year;
b. Addresses the previous year’s goals with a
level of success and, if applicable, identifies any obstacles encountered;
c. Identifies the individual’s goals for the
coming year;
d. Identifies the type and amount of services
the individual receives and the support services provided under each service
category;
e. Identifies the individual’s health needs;
f. Identifies the individual’s safety needs;
g. Identifies any follow-up action needed on
concerns and the persons responsible for the follow-up; and
h. Includes a statement of the individual’s and
guardian’s satisfaction with services;
(4) An attached work history of the person’s paid
employment and volunteer positions, as applicable, that includes:
a. Dates of employment;
b. Type of work;
c. Hours worked per week; and
d. Reason for leaving, if applicable; and
(5) A reference to sensitive historical
information in other sections of the chart when the individual, guardian, or
representative, as applicable, prefers not to have this included in the
profile.
(ab)
“Provider” means a person receiving any form of remuneration for the provision
of services to an individual.
(ac)
“Provider agency” means an area agency or another entity under contract
with an area agency to provide services.
(ad) “Region” means “area” as defined in RSA
171-A:2, I-a, namely, “a geographic
region established by rules adopted by the commissioner for the purpose of
providing services to developmentally disabled persons.”
(ae)
“Representative” means:
(1) The parent or guardian of an individual under
the age of 18;
(2) The guardian of an individual 18 or over; or
(3) A person who has power of attorney for the individual
granting specific authority to make the required decision.
(af)
“Risk assessment” means an evaluation administered pursuant to He-M
522.10 (d)(13) using evidence-based tools to evaluate an individual’s behaviors
and determine the potential risks to the individual or others posed by said
behaviors.
(ag)
“Service” means any paid assistance to the individual in meeting his or
her own needs provided through the area agency.
(ah) “Service agreement” means a
written agreement between the individual, guardian, or representative and the
area agency that was prepared as a result of the person-centered planning
process and that describes the services that an individual will receive and
constitutes an individual service agreement as defined in RSA 171-A:2, X. The term includes a basic service agreement
for all individuals who receive services and an expanded service agreement for
those who receive more complex services pursuant to He-M 522.11.
(ai)
“Service coordinator” means a person who meets the criteria in He-M 522.09 (e)-(f) and is chosen
or approved by an individual and his or her guardian or representative to organize,
facilitate, and document service planning and to negotiate and monitor the
provision of the individual’s services and who is:
(1) An area agency service coordinator, family
support coordinator, or any other area agency or provider agency employee who
does not provide or have oversight of any direct services for the individual;
(2) A member of the individual’s family;
(3) A friend of the individual; or
(4) Another person chosen to represent the
individual.
(aj) “Service planning
meeting” means a gathering of 2 or more people, one of whom is the individual
who receives services unless he or she chooses not to attend, called to
develop, review, add to, delete from, or otherwise change a service agreement.
(ak)
“Specific learning disability” means a chronic condition of presumed
neurological origin that selectively interferes with the development, integration,
or demonstration of verbal or non-verbal abilities, and constitutes a severe
disability to such individual’s ability to function normally in society. The term includes such conditions as
perceptual handicaps, brain injury, dyslexia, and developmental aphasia. The term does not include individuals who
have learning problems which are primarily the result of visual, hearing, or
motor handicaps, intellectual disability, emotional disturbance, or environmental,
cultural, or economic disadvantage.
(al) “State of residence” means the state of
residence as defined in 42 CFR 435.403.
(am)
“Supports intensity scale (SIS)” means the 2004 edition of the Supports
Intensity Scale, available as noted in Appendix A, which is an assessment tool
intended to assist in service planning by measuring the individual’s support
needs in the areas of home living, community living, lifelong learning, employment,
health and safety, social activities, protection, and advocacy. The tool uses a formal rating scale to identify
the type of supports needed, frequency of supports needed, and daily support
time.
(an)
“Termination” means the cessation of a service by an area agency
director with or without the informed consent of the individual or his or her
guardian or representative.
(ao) “Vacancy” means funds that become available
when an individual stops
receiving acquired brain disorder services.
(ap)
“Wait list” means a list of individuals who need and are ready to receive
services, are medicaid eligible, but who do not have funding for services
needed.
(aq)
“Withdrawal” means the choice of an individual or his or her guardian to
discontinue that individual’s participation in a service.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff 10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18
He-M 522.03
Eligibility for Services.
(a) As referenced in He-M 522.02(a) and (al), any
person whose state of residence is New Hampshire and who has an acquired brain disorder shall be eligible for service coordination and community support.
(b) Individuals described in (a) above shall also be
eligible for Medicaid home- and community-based care
services if they meet the requirements of He-M 517.03(a).
(c) Any applicant for services whose suspected acquired brain
disorder occurred prior to age 22 shall be evaluated pursuant to He-M 503.05 to determine whether he or she has a brain injury
that meets the criteria for developmental disability. If the applicant has a developmental disability, he or she shall be provided
services pursuant to He-M 503.09 and He-M 503.10. If the applicant is determined not to have a developmental
disability, he or she shall
be evaluated for eligibility pursuant to He-M 522.05.
(d) Eligibility for services shall be reviewed
pursuant to He-M 522.07.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18
He-M
522.04 Application for Services.
(a)
Application for services shall be made by:
(1) The applicant;
(2) A guardian of an applicant under the age of
18;
(3) A guardian of an applicant age 18 or over if a
guardian of the person has been appointed by the probate court pursuant to RSA
464-A; or
(4) A representative of the applicant authorized
to make such application.
(b)
An application for services shall be made in writing to the area agency
in the applicant’s region of
residence.
(c)
An area agency shall explain the eligibility process and offer
assistance to the applicant, guardian, or representative in making application
for services.
(d)
The area agency shall inform the applicant, guardian, or representative
of its roles and responsibilities and provide information about:
(1) The types of evaluations, assessments, and
screenings needed to assist in the development of the service agreement;
(2) Eligibility determination;
(3) Service coordination;
(4) Service agreement development and review;
(5) Services provided by the area agency and the
assistance available to identify the services that are required;
(6) Service provision;
(7) Service monitoring; and
(8) Choice of provider for all services.
(e)
An area agency shall request each applicant to authorize release of
information to permit the area agency to access relevant current and historical
records and information regarding the applicant’s:
(1) Acquired brain disorder;
(2) Personal, family, social, educational, neuropsychological, medical,
and rehabilitation status;
and
(3) Functional abilities, interests, and
aptitudes.
(f) Authorization to release
information shall specify:
(1) The name of the applicant and the information
to be released;
(2) The name of the person or organization being
authorized to release the information;
(3) The name of the person or organization to
whom the information is to be released; and
(4) The time period for which the authorization
is given, which shall not exceed one year.
(g) To provide
comprehensive, efficient, and coordinated services, the area agency shall
undertake a review of the public and private benefits and resources that are
available to the applicant.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18
He-M 522.05
Determination of Eligibility as a Person with an Acquired Brain Disorder.
(a)
To determine the existence of an applicant’s acquired brain disorder,
the area agency shall perform an evaluation by:
(1) Completing a review of available assessments of the applicant’s
physical, intellectual, cognitive, and behavioral status and an age-appropriate standardized
functional assessment; or
(2) If the information
available is not adequate to make a determination, coordinating additional physical,
neuropsychological, neurological, functional, and behavioral assessments and
evaluations as necessary to make the determination.
(b)
The results of the review and assessments pursuant to (a) above and any
other information concerning the applicant’s disability shall be the basis for
determination of eligibility pursuant to He-M 522.03(a) and assist in the
identification of needs and provision of services.
(c)
To the extent possible, the area agency shall utilize generic resources
to pay for an applicant’s review and assessments. Such resources shall, with the applicant’s
consent, include private and public insurance.
(d)
An area agency shall
review the information it has received regarding an applicant and,
within 15 business days after the receipt of the completed application, make a
decision on the eligibility of the applicant in accordance with He-M
522.03(a). If the information required
to determine eligibility cannot be obtained within these timelines, the area agency
shall request an extension from the applicant, guardian, or representative,
state the reason for the delay and obtain approval in writing. This extension shall not exceed 30 business
days after the receipt of application.
(e)
In cases where the information on eligibility is inconclusive, the area
agency may consult the department regarding determination of eligibility. If it is anticipated that eligibility will
not be determined within the timelines stated in (d) above, the area agency
shall request an extension from the applicant, guardian, or representative,
state the reason for the delay, and obtain approval in writing. This extension shall not exceed 30 business
days after the receipt of application.
(f)
If the area agency request for an extension pursuant to (d) or (e) above
is denied by the applicant, guardian, or representative, the area agency shall
determine the applicant to be ineligible for services. The applicant, representative, or guardian
may reapply for services pursuant to (k) below.
(g) In an emergency situation, temporary service
arrangements may be made
prior to the completion of the eligibility determination process if the
area agency director or designee and bureau administrator or designee first
determine that the criteria in He-M 522.14(i) are met.
(h) For an applicant found eligible under He-M
522.03(a) for service coordination and brain injury community support, within 3
business days the area agency shall:
(1) Make a
written referral to the department for additional determination of eligibility
under He-M 522.06(a); and
(2) Notify
the individual or guardian, if applicable, in writing regarding his or her
eligibility for service coordination and that the application is being
forwarded to the department for eligibility determination under He-M 522.06(a).
(i)
Preliminary planning to determine the services needed shall occur with the
individual and guardian or representative at the time of intake or during
subsequent discussions. Preliminary
evaluations shall be completed and preliminary recommendations for services
shall be made within 21 days of application for service, or within 5 days of an
eligibility determination made after extension pursuant to (d) or (e) above.
(j)
Within 3 days of determination of an applicant’s ineligibility, an area
agency shall convey to the applicant, guardian, or representative a written decision that
describes the specific legal and factual basis for the denial, including
specific citation of the applicable law or department rule(s), and advise the
applicant in writing and verbally of his or her appeal rights under He-M 522.18.
(k) Following denial of eligibility, the
applicant, , guardian, or representative, as applicable, may reapply for
services if new information regarding the diagnosis, level of care, or severity of the disability or functional impairment related to the acquired
brain disorder becomes available.
(l)
The determination of eligibility by one area agency shall be controlling
on any other area agency in the state.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff 11-30-18
He-M 522.06 Determination of
Eligibility for Medicaid Home- and Community-based Care Services.
(a) For those persons found eligible under He-M
522.03(a), the department shall review the referral made pursuant to He-M
522.05(h)(1) and shall, within 15 business days of receipt of the referral,
make a decision on eligibility under He-M 522.03(b). This decision shall be
conveyed to the applicant and representative or guardian, if applicable, in
writing and include the specific legal and factual basis for the determination,
including specific citation of the applicable law or department rule.
(b)
Within 3 business days of receipt of the department’s determination regarding
an applicant’s eligibility under He-M 522.03(b), an area agency shall issue written
notice to the applicant and guardian, if applicable, as follows:
(1) For an
applicant eligible for services under He-M 522.03(b), notice shall include the
name of the area agency contact person and state that the applicant is eligible
under He-M 522.03(a) for service coordination and He-M 522.03(b) for medicaid
home- and community-based care services;
(2) For an
applicant not eligible under He-M 522.03(b), notice shall include:
a. The
specific legal and factual basis for the determination, including specific
citation of the applicable law or department rule; and
b. Written
and verbal notice of the appeal rights under He-M 522.18.
(c) Following denial of eligibility, the
individual, representative or guardian, as applicable, may reapply for services
if new information regarding the diagnosis, level of care, or severity of the
disability or functional impairment related to the acquired brain disorder
becomes available.
(d) The determination of eligibility under He-M
522 by one area agency shall be controlling on every other area agency of the
state.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18
He-M 522.07 Periodic Review of Eligibility.
(a) If there is reason to believe that the
individual’s level of cognitive functioning or adaptive behavior has changed
and the person no longer has an acquired brain disorder as defined in He-M
522.02(a), or a need for services pursuant to He-M 517.03(a)(4)b., the area
agency shall notify the individual receiving services, or the representative or
guardian if the individual has one, and arrange for a reassessment of
eligibility. The individual,
representative, or guardian shall have the right to submit additional
evaluations, letters, or other information regarding continued eligibility
which shall be considered by the area agency or department prior to issuing a
decision.
(b) If the results of the above reassessment
demonstrate that the person no longer meets the criteria for eligibility in
He-M 522.03(a) or (b), the area agency shall inform the person, representative,
or guardian in writing of the determination and phase out the relevant services
over the 12 months following the redetermination.
(c)
In each instance where the reassessment leads to a denial of
eligibility, the area agency shall in writing;
(1) Inform the applicant, guardian, or
representative of the determination;
(2) Describe the specific legal and factual basis
for the denial, including specific citation of the applicable law or department
rule; and
(3) Advise the applicant, representative, or
guardian of the appeal rights under He-M 522.18.
(d) A person or guardian may appeal a denial of
eligibility based on redetermination pursuant to He-M 202.08 and He-C 200.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10 (from He-M 522.06); ss by
#12683, eff 11-30-18
He-M 522.08 Service
Guarantees.
(a)
All services
shall:
(1) Be voluntary;
(2) Be provided only after the informed consent of
the individual, guardian, or representative;
(3) Comply with the rights of the individual
established under He-M 310; and
(4) Facilitate as much as possible the
individual’s ability to determine and direct the services he or she will
receive.
(b)
All services shall be designed to:
(1) Promote the individual’s personal development
and quality of life in a manner that is determined by the individual;
(2) Meet the individual’s needs in personal care,
employment, and leisure activities;
(3) Meet the individual’s needs in adult basic
education:
a. Including educational activities with the
purpose of assisting the individual in attaining or enhancing community living
skills or adaptive skill development to assist the individual in residing in
the most appropriate setting for his or her needs; and
b. Not including post-secondary education;
(4) Promote the individual’s health and safety
within the bounds of reasonable risk;
(5) Protect the individual’s right to freedom
from abuse, neglect, and exploitation;
(6) Increase the individual’s participation in a
variety of integrated activities and settings;
(7) Provide opportunities for the individual to
exercise personal choice, independence, and autonomy within the bounds of
reasonable risks;
(8) Enhance the individual’s ability to perform
personally meaningful or functional activities;
(9) Assist the individual to acquire and maintain
life skills, such as, managing a personal budget, participating in meal
preparation, or traveling safely in the community, including accessing
community transportation; and
(10) Be provided in such a way that the individual
is seen as a valued, contributing member of his or her community.
(c)
The environment or setting in which an individual receives services
shall be the least restrictive, most integrated setting that promotes that
individual’s:
(1) Freedom of movement;
(2) Ability to make informed decisions;
(3) Self-determination; and
(4) Participation in the community.
(d)
An individual, guardian, or representative may select any person,
provider agency, or another area agency as a provider to deliver one or more of
the services identified in the individual’s service agreement. The area agency shall provide
information at intake and at a minimum at each annual service agreement meeting
regarding choice.
(e) All providers shall comply with the rules
pertaining to the service(s) offered and meet the provisions specified within the
individual’s service agreement. Providers shall also enter
into a contractual agreement with the area agency and operate within the limits
of funding authorized by it.
(f) After discussions with
the individual, guardian, or representative and proposed or current provider,
if the area agency determines that a provider chosen by the individual,
guardian, or representative is a new provider that proposes a service
arrangement which is not in accordance with department rules, or is a provider
that has not been in compliance with department rules in the past, the area agency
shall:
(1) Provide a written rationale to the
individual, guardian, or representative stating the reasons why the area agency
will not enter into a service contract with the provider; and
(2) With input from the individual, guardian, or
representative, identify another provider.
(g) After
discussions with the individual, guardian, or representative and proposed or
current provider, if the area agency determines that a provider chosen by the
individual, guardian, or representative is not implementing the service
agreement, providing for the health and safety of the individual, or in
compliance with applicable rules while providing services, the area agency
shall:
(1) Terminate the service contract with the
provider with a 30 day notice; and
(2) With input from the individual, guardian, or
representative, establish another service arrangement and amend the service
agreement.
(h) If the area agency
determines that a provider chosen by the individual, guardian, or
representative is posing a serious threat to the health or safety of the
individual, the area agency shall, with input from the individual, guardian, or
representative, secure another provider and issue a notice to immediately
terminate the service contract of the current provider, specifying the reasons
for the action.
(i) The individual, guardian,
or representative may appeal the area agency’s decision under (e) or (f) above. At the time it provides notice, the area
agency shall advise the individual, guardian, or representative in writing of
his or her appeal rights under He-M 522.18.
(j)
An area agency shall create
service agreements
for all individuals for
whom funding for medicaid home- and community-based care services is available pursuant to He-M 517.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10 (from He-M 522.07); ss by
#12683, eff 11-30-18 (formerly He-M 522.09)
He-M 522.09 Service
Coordination.
(a)
The service coordinator shall be a person chosen by the individual,
guardian, or representative who meets the criteria in He-M 506.03(b)-(g) and He-M
522.09(e)-(f) below.
(b) The area agency shall advise the individual
and guardian
or representative in writing within 5 days
of the determination of eligibility and each year prior to the annual service
planning meeting under He-M 522.10 and He-M 522.11
that he or she has a right to choose his or her own service coordinator,
including one who is not employed by the area agency.
(c) For those individuals not eligible for
medicaid home- and community-based care services pursuant to He-M 517, the
service coordinator shall:
(1) Hold a
planning session to identify service needs and goals and appropriate community
resources;
(2) Make
appropriate referrals to community agencies; and
(3) Advocate
on behalf of the individual for services to be provided in accordance with He-M
522.
(d) For those individuals eligible under He-M
517.03, the service coordinator shall:
(1) Advocate on behalf of individuals for
services to be provided in accordance with He-M 522.08(b);
(2) Coordinate the service planning process in
accordance with He-M 522.08,
He-M 522.10, and He-M 522.11;
(3) Describe to the individual, guardian, or
representative service provision options such as participant directed and
managed services;
(4) Monitor and document services provided to the
individual;
(5) Ensure continuity and quality of services
provided;
(6) Ensure that service documentation is
maintained pursuant to He-M 522.11
(c), (h)(1)
and (m)(2)-(3);
(7) Determine and implement necessary action and
document resolution when goals are not being addressed, support services are
not being provided in accordance with the service agreement, or health or
safety issues have arisen;
(8) Convene service planning meetings at least
annually and whenever:
a. The individual, guardian, or representative
is not satisfied with the services received;
b. There is no progress on the goals after follow-up
interventions;
c. The individual’s needs change;
d. There is a need for a new provider; or
e. The individual, guardian, or representative
requests a meeting;
(9) Document service coordination visits and contacts
pursuant to He-M 522.10(n)
and He-M 522.11 (m)(2)-(4);
(10) In advance of the annual service planning
meeting, either during the quarterly meeting held prior to the expiration of
the service agreement or at least 45 days prior to the expiration of the
service agreement:
a. Ensure that all needed evaluations, screenings,
or assessments, such as the SIS, HRST, assistive technology evaluation, risk
assessments, behavior plans, and other clinical or health evaluations are
updated and, if necessary, performed and that information from said evaluations,
screenings, and assessments is discussed and shared with the individual,
guardian, or representative;
b. Identify risk factors and plans to minimize
them;
c. Assess the individual’s interest in, or
satisfaction with, employment; and
d. Discuss and assess the individual’s progress
on goals and preparing for the development of new goals to be included in the
new service agreement; and
(11) Assist the individual, guardian, or representative
to maintain the individual’s public benefits.
(e)
A service coordinator shall not:
(1) Be a guardian or representative of the
individual whose services he or she is coordinating;
(2) Have a felony conviction;
(3) Have been found to have abused or neglected
an adult with a disability based on a protective investigation performed by the
bureau of elderly and adult services in accordance with He-E 700 and an
administrative hearing held pursuant to He-C 200, if such a hearing is
requested;
(4) Be listed in the state registry of abuse and
neglect pursuant to RSA 169-C:35 or RSA 161-F:49; or
(5) Have a conflict of interest concerning the
individual, such as providing other direct services to the individual.
(f)
If the service coordinator chosen by the individual, guardian, or
representative is not employed by the area agency or its subcontractor:
(1) The service coordinator and area agency shall
enter into an agreement which describes:
a. The role(s) set
forth in He-M 522.09
for which the service coordinator assumes responsibility;
b. The reimbursement, if any, provided by the
area agency to the service coordinator;
c. The oversight activities to be provided by the
area agency; and
d. Compliance with (e) above;
(2) If the area agency determines that the
service coordinator is not acting in the best interest of the individual or is
not fulfilling his or her obligations as described in the letter of agreement,
the area agency shall revoke the designation of the service coordinator with a
30-day notice and designate a new service coordinator, with input from the
individual, guardian, or representative, pursuant to (a) above; and
(3) If the area agency determines that a service
coordinator chosen by the individual, guardian, or representative is posing an
immediate and serious threat to the health or safety of the individual, the
area agency shall terminate the designation of the service coordinator
immediately upon issuance of written notice specifying the reasons for the
action and designate a new service coordinator, with input from the individual,
guardian, or representative, pursuant to
(a) above.
(g)
The individual, guardian, or representative may appeal the area agency’s
decision under (f)(2) or (3) above about a service coordinator pursuant to He-M
522.18. At the time it provides notice
under (f)(2) or (3) above, the area agency shall advise the individual,
guardian, or representative in writing of his or her appeal rights under He-M
522.18.
(h)
The role of service coordinator may, by mutual agreement, be shared by an
employee of the area agency and another person.
Such agreements shall be in writing and clearly indicate which functions
each service coordinator will perform.
(i)
For individuals who receive services from both the developmental
services and behavioral health services systems, service coordination shall be
billed only by the area agency or behavioral health agency that is the primary
service provider, pursuant to He-M 426.15(a)(6).
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10 (from He-M 522.08); ss by
#12683, eff 11-30-18 (formerly He-M 522.10)
He-M 522.10 Service Planning
for Individuals Eligible for Medicaid Home- and Community-based Care Services.
(a)
Within 5 days of the determination of eligibility, the area agency shall
have conducted sufficient preliminary planning with the individual and the
guardian or representative at the time of intake or during subsequent
discussions to identify and document the specific services needed based on
information obtained pursuant to He-M 522.05(a).
(b) The service coordinator shall hold an
initial service planning meeting with the individual, the individual’s guardian
or representative, and any other person chosen by the individual within 30 days
of the determination of eligibility.
(c)
Service coordinators shall facilitate service planning to develop
service agreements in accordance with He-M 522.11. Service agreements shall be prepared
initially according to the timeframe specified in He-M 522.11(c) and annually
thereafter, as required by He-M 522.09(d)(8).
(d)
All service planning shall occur through a person-centered planning
process that:
(1) Maximizes the decision-making of the
individual;
(2) Is directed by the individual or the
individual’s guardian or representative;
(3) Facilitates personal choice by providing information
and support to assist the individual to direct the process, including
information describing:
a. The array of services and service providers
available; and
b. Options
regarding self-direction of services;
(4) Includes participants freely chosen by the
individual;
(5) Reflects cultural considerations of the
individual and is conducted in clearly understandable language and form;
(6) Occurs at a time and location of convenience
to the individual, guardian, or representative;
(7) Includes strategies for solving conflict or
disagreement within the process, including clear conflict of interest
guidelines for all planning participants;
(8) Is consistent with an individual’s rights to
privacy, dignity, respect, and freedom from coercion and restraint;
(9) Includes a method for the individual,
guardian, or representative to request amendments to the plan;
(10) Records the alternative medicaid home- and
community-based settings that were considered by the individual, guardian, or
representative;
(11) Includes information obtained through utilization
of the SIS,for individuals aged 16 or older, which shall be administered:
a. Initially, for each individual receiving
funded community participation services pursuant to He-M 507, community support
services pursuant to He-M 517.05(k), employment services pursuant to He-M 518,
residential services pursuant to He-M 1001, residential and community support
services provided in the family home pursuant to He-M 521, or
participant-directed and managed services pursuant to He-M 525;
b. Upon an individual’s entry onto the wait
list;
c. Upon a significant change as defined under SIS
protocols; and
d. Five years following each prior
administration;
(12) Includes information obtained through the HRST,
which shall be administered:
a. Within 30 days of the initiation of services;
b. Within one year of the effective date of
these rules, for each individual receiving funded community participation services
pursuant to He-M 507, community support services pursuant to He-M 517.05(k),
employment services pursuant to He-M 518, residential services pursuant to He-M
1001, participant-directed and managed services pursuant to He-M 525, or
in-home support services pursuant to He-M 524; and
c. Annually or upon significant change in an
individual’s status;
(13) Includes information obtained through a risk
assessment, which shall be administered:
a. To each individual with a history of, or
exhibiting signs of, behaviors that pose a potentially serious likelihood of
danger to self or others, or a serious threat of substantial damage to real
property, such as:
(i) Sexual offending;
(ii) Violent aggression;
(iii) Arson; or
(iv) Other similar violent or dangerous events;
b. Upon the earlier of said individual’s entry
onto the wait list or the individual’s receiving services under He-M 500;
c. Prior to any significant change in the level
of the individual’s treatment or supervision;
d. At any time an individual who previously has
not had a risk assessment begins to engage in behaviors referenced in a. above;
and
e. By an evaluator with specialized experience,
training, and expertise in the treatment of the types of behaviors referenced
in a. above;
(14) Includes information from specialty medical and
health assessments and clinical assessments as needed, including, at a minimum,
communication, assistive technology, and functional behavior assessments;
(15) Includes information from personal safety
assessments pursuant to He-M 1001.06(ab), as applicable;
(16) Includes strategies to address co-occurring
severe mental illness or behavioral challenges which are interfering with the
individual’s functioning, including positive behavior plans or other strategies
based on functional behavior or other evaluations or referrals to behavioral
health services;
(17) Includes individualized backup plans and
strategies;
(18) Provides a method to request updates;
(19) Includes strategies for solving disagreements;
(20) Uses a strengths-based approach to identify
the positive attributes of the individual;
(21) Includes the
provision of auxiliary aids and services when needed for effective communication,
including low literacy materials and interpreters;
(22) Addresses the individual’s concerns about current
or contemplated guardianship or other legal assignment of rights; and
(23) Explores housing and employment in integrated
settings, and develops plans consistent with the individual’s goals and preferences.
(e)
A copy of the completed plan shall be signed by all persons responsible
for its implementation and be provided to the individual and his or her
representative.
(f) The service coordinator shall document that he
or she has, as applicable, maximized the extent to which an individual participates
in and directs his or her person-centered planning process by:
(1) Explaining to the individual the
person-centered planning process and providing the information and support
necessary to ensure that the individual directs the process to the maximum
extent possible within the scope of He-M 522;
(2) Explaining to the individual his or her
rights and responsibilities;
(3) Providing the
individual with information regarding the services and service providers
available;
(4) Eliciting information from the individual
regarding his or her personal preferences and service needs, including any
health concerns, that shall be a focus of service planning meetings;
(5) Determining with the individual issues to be
discussed during all service planning meetings; and
(6) Explaining to the individual the limits of
the decision-making authority of the guardian or representative, if applicable,
and the individual’s right to make all other decisions related to services.
(g)
The individual, guardian, or representative may determine the following
elements of the service planning process:
(1) The number and length of meetings;
(2) The location, date, and time of meetings;
(3) The meeting participants;
(4) Topics to be discussed; and
(5) Whether any additional assessments or
evaluations are needed to assist in the development of the service agreement.
(h)
In order to develop or revise a service agreement to the satisfaction of
the individual, guardian, or representative, the service planning process shall
consist of periodic and ongoing discussions regarding elements identified in
He-M 522.08(b) that shall:
(1) Include the individual and other persons
involved in his or her life;
(2) Are facilitated by a service coordinator; and
(3) Are focused on the individual’s abilities,
health, interests, and achievements.
(i)
The service planning process shall include a discussion regarding whether
or not there is a need for a limited or full guardianship, conservatorship,
representative payee for social security benefits, durable power of attorney,
durable power of attorney for healthcare, or other less restrictive
alternatives to guardianship. The
discussion and any recommendations shall be incorporated into the service
agreement and the area agency director shall implement any such recommendations.
(j)
The service planning process shall include a discussion of the need for
assistive technology that could be utilized to support all services and activities
identified in the proposed service agreement without regard to the individual’s
current use of assistive technology.
(k)
Service agreements shall be reviewed by the area agency with the
individual, guardian, or representative at least once during the first 6 months
of service and as needed. The annual review
required by He-M 522.09(d)(8)
shall include a service planning meeting.
(l)
The reviews required in (k) above shall include, at a minimum, the
following:
(1) A thorough clinical examination including an
annual health assessment;
(2) An assessment of the individual’s capacity to
make informed decisions; and
(3) Consideration of less restrictive
alternatives for service.
(m)
The individual, guardian, or representative may request, in writing, a
delay in an initial or annual service agreement planning meeting. The area agency shall honor this request.
(n)
The service coordinator shall be responsible for monitoring services identified
in the service agreement and for assessing individual, guardian, or
representative satisfaction at least annually for basic service agreements and
quarterly for expanded service agreements.
(o) An area agency director, service
coordinator, service provider, individual, guardian, or representative shall
have the authority to request a service planning meeting when:
(1) The individual’s responses to services
indicate the need;
(2) A change to another service is desired;
(3) A personal crisis has developed for the
individual; or
(4) A service agreement
is not being carried out in accordance with its terms.
(p)
At a meeting held pursuant to (o) above, the participants shall document whether and how
to modify the service agreement.
(q)
Service agreement amendments may be proposed at any time. Any amendment shall be made with the documented
consent of the individual, guardian, or representative and the area agency on
the “Amendment(s) to Service Agreement” (2015 edition).
(r) If the individual, guardian, representative,
or area agency director disapproves of the service agreement, the dispute shall
be resolved:
(1) Through informal discussions between the
individual, guardian, or representative and service coordinator;
(2) By reconvening a service planning meeting; or
(3) By the individual, guardian, or
representative filing an appeal to the department pursuant to He-C 200.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10 (from He-M 522.09); ss by
#12683, eff 11-30-18 (formerly He-M 522.11)
He-M
522.11 Service Agreements for
Individuals Eligible for Medicaid Home- and Community-based Care Services.
(a)
The area agency shall create service agreements for all individuals in
accordance with (b)-(j) below.
(b) All service agreements shall:
(1) Be understandable to the individual,
guardian, or representative and all service providers responsible for providing
services;
(2) At a minimum, be written in plain language
and in a manner accessible and understandable to individuals with disabilities
and persons who have limited proficiency in english;
(3) Be finalized and agreed to in writing by the
individual, guardian, or representative and signed by all providers responsible
for the implementation of the service agreement;
(4) Be written such that no unnecessary or
inappropriate services or supports will be provided to the individual; and
(5) Be distributed to the individual, guardian,
or representative and all providers, including direct support providers,
responsible for the implementation or monitoring of the service agreement.
(c)
Within 14 days of the initial service agreement meeting pursuant to He-M
522.10(b), the service coordinator shall develop a written basic service agreement,
signed by the individual, guardian, or representative and the area agency
executive director or designee, that includes the following:
(1) A brief description of the individual’s
strengths, needs, and interests, as applicable;
(2) The individual’s clinical and support needs
as identified through current evaluations and assessments;
(3) The specific services to be furnished and the
goal associated with each service;
(4) The amount, frequency, duration, and desired
outcome of each service;
(5) Timelines for initiation of services;
(6) The provider to furnish the service;
(7) The individual’s need for guardianship;
(8) Service documentation requirements sufficient
to track outcomes;
(9) Identification of the person or entity
responsible for monitoring the plan;
(10) Documentation that the setting the individual
resides in was chosen by the individual, guardian, or representative and is integrated in, and
supports full access of the individual to the greater community, including opportunities
to seek employment and work in competitive integrated settings, engage in
community life, control personal resources, and receive services in the
community to the same degree of access as people not receiving services;
(11) Documentation that the setting is selected by
the individual from among setting options, including non-disability specific
settings and an option for a private unit in a residential setting, and that the
settings options are identified and based on the individual’s needs, and
preferences;
(12) Documentation that any restriction on the right
of an individual to realize his or her preferences or goals in the services
plan is justified by:
a. An identified specific and individualized
need that the modification is based on;
b. The positive
interventions and supports used prior to any modifications to the individual’s
rights;
c. The less intrusive methods of meeting the need
that were tried but did not work;
d. A clear description of the condition that is
directly proportionate to the specific assessed need;
e. The regular collection and review of data to
measure the ongoing effectiveness of the modification;
f. Established time limits for periodic reviews
of the necessity of the modification;
g. The informed consent of the individual,
guardian, or representative;
h. An assurance that the modification will not
cause harm to the individual; and
(13) For individuals with a participant directed and
managed service arrangement, reporting mechanisms regarding budget updates.
(d)
For services provided under He-M 1001, He-M 521, He-M 525, He-M 518,
He-M 507, or per individual or guardian request, an expanded service agreement
shall be developed pursuant to (e)-(k) below.
(e)
The service coordinator shall convene a meeting to prepare an expanded
service agreement in accordance with (f)–(k) below within 20 business days of the initiation of services.
(f) If people who provide services to the individual
are not selected by the individual to participate in a service planning
meeting, the service coordinator shall contact such persons prior to the
meeting so that their input can be considered.
(g)
Copies of relevant evaluations and reports shall be sent to the
individual and guardian at least 5 business days before service planning meetings.
(h)
Within 10 business days following a service planning meeting pursuant to
(e) above, the service coordinator shall:
(1) Prepare a written expanded service agreement
that includes the following:
a. A personal profile;
b. A list of those who participated in the
service agreement planning meeting;
c. The information included in the basic service
agreement pursuant to He-M 503.10(c);
d. The specific services to be provided;
e. The goals to be addressed, timelines, and
methods for achieving them;
f. The persons responsible for implementing each
service in the expanded service agreement;
g. Any training needed to carry out the service
agreement, beyond the staff training required by He-M 506.05 and other applicable
rules, with the type and amount of such training to be determined by the
service agreement participants;
h. Services needed but not currently available;
i. Service documentation requirements sufficient
to describe progress on goals and the services received;
j. If applicable, reporting mechanisms under
self-directed services regarding budget updates and individual and guardian
satisfaction with services;
k. If applicable, risk factors and the measures
required to be in place to minimize them, including backup plans and
strategies; and
l. The individual’s need for guardianship, if
any.
(2) Contact all persons who have been identified
to provide a service to the individual and confirm arrangements for providing
such services; and
(3) Explain the service arrangements to the
individual and guardian or representative and confirm that they are to the
individual’s and guardian’s or representative’s satisfaction.
(i)
For individuals who reside in a provider owned or controlled residential
setting, the service agreement shall document any modifications of the individual’s
rights in the residential setting to
include:
(1) Privacy in their sleeping or living unit,
including doors lockable by the individual with only appropriate staff having
keys to doors as needed;
(2) Freedom and support to control their own
schedule and activities;
(3) Access to food at any time;
(4) Having visitors of their choosing at any time;
and
(5) Freedom to furnish and decorate sleeping or living
units.
(j)
A provider agency shall only make modifications pursuant to (i) above by
documenting in the service agreement the following:
(1) An identified specific and individualized
assessed need that the modifications are based on;
(2) The positive interventions and supports used
prior to any modifications to the service agreement;
(3) The less intrusive methods used to attempt to
meet the need but was unsuccessful;
(4) A clear description of the condition that is
directly proportionate to the specific assessed need;
(5) The regular collection and review of data to
measure the ongoing effectiveness of the modification;
(6) Established time limits for periodic reviews
to determine if the modification is still necessary or can be terminated;
(7) The informed consent of the individual or
representative; and
(8) An assurance that the interventions and
support will not cause harm to the individual.
(k)
Within 5 business days of completion of the service agreement, the area
agency shall send the individual, guardian, or representative the following:
(1) A copy of the expanded service agreement
signed by the area agency executive director or designee;
(2) The name, address, email, and phone number of
the service coordinator or service provider(s) who may be contacted to respond
to questions or concerns; and
(3) A description of the procedures for
challenging the proposed expanded service agreement pursuant to He-M 522.18 for those situations
where the individual, guardian, or representative disapproves of the expanded
service agreement.
(l)
The individual, guardian, or representative shall have 10 business days
from the date of receipt of the expanded service agreement to respond in writing,
indicating approval or disapproval of the service agreement. Unless otherwise arranged between the
individual, guardian, or representative and the area agency, failure to respond
within the time allowed shall constitute approval of the service agreement.
(m)
When an expanded service agreement has been approved by the individual,
guardian, or representative and area agency director, the services shall be
implemented and monitored as follows:
(1) A person responsible for implementing any part
of an expanded service agreement, including goals and support services, shall
collect and record information about services provided and summarize progress
as required by the service agreement or, at a minimum, monthly;
(2) On at least a monthly basis, the service
coordinator shall visit or have verbal contact with the individual or persons
responsible for implementing an expanded service agreement and document these
contacts;
(3) The service coordinator shall visit the
individual and contact the guardian, if any, at least quarterly, or more
frequently if so specified in the individual’s expanded service agreement, to
determine and document:
a. Whether services match the interests and
needs of the individual;
b. The individual’s and guardian’s or representative’s
satisfaction with services; and
c. Progress on the goals in the expanded service
agreement; and
(4) If the individual receives services under
He-M 1001, He-M 521 or He-M 524, at least 2 of the service coordinator’s
quarterly visits with the individual shall be in the home where the individual
resides.
(n) Service agreements shall be renewed at least
annually.
(o) Service agreements shall be reviewed and
revised:
(1) When the individual’s circumstances or needs
change; or
(2) At the request of the individual, guardian,
or representative.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10); ss by #12683, eff
11-30-18 (formerly He-M 522.12)
He-M 522.12
Record Requirements for Area Agencies.
(a)
Service coordinators or their designees shall maintain a separate record
for each individual who receives services and ensure the confidentiality of
information pertaining to the individual, including:
(1) Maintaining the confidentiality of any
personal data in the records;
(2) Storing and disposing of records in a manner
that preserves confidentiality; and
(3) Obtaining a release of information pursuant
to He-M 522.04(e) prior to release of any
part of a record to a third party.
(b)
An individual’s record shall include:
(1) Personal and identifying information including
the individual’s:
a. Name;
b. Address;
c. Date of birth; and
d. Telephone number;
(2) All information used to determine eligibility
for services pursuant to He-M 522.05, He-M
522.06, and He-M 522.07;
(3) Information about the individual that would
be essential in case of an emergency, including:
a. Name, address, and telephone number of the legal guardian, representative, next of
kin, or other person to be
notified;
b. Name, addresses, and telephone numbers of current service providers; and
c. Medical information, including:
1. Diagnosis(es);
2. Health history;
3. Allergies;
4. Do not resuscitate (DNR) orders, as appropriate;
and
5. Advance directives, as determined by the
individual;
(4) A copy of the individual’s current service
agreement;
(5) Copies of all service agreement amendments;
(6) Progress notes on goals and support services
provided as identified in the service agreement;
(7) All service
coordination contact notes and quarterly assessments pursuant to He-M 522.11(m)(2)-(4);
(8) Copies of evaluations and reviews by providers
and professionals;
(9) Copies of
correspondence within the past year with the individual and guardian or representative, service providers, physicians,
attorneys, state and federal agencies, family members, and others in the
individual’s life;
(10) Other correspondence or memoranda concerning
any significant events in the individual’s life;
(11) Information about transfer or termination of
services, as appropriate; and
(12) Proof that the individual was given choice of
provider.
(c)
All entries made into an individual record shall be legible and dated and
have the author identified by name and position.
(d)
In addition to the documentation requirements identified in He-M 522, each area agency
shall comply with all applicable documentation requirements of other department
rules.
(e)
Each area agency shall:
(1) Retain records supporting each medicaid bill
for a period of not less than 6 years; and
(2) Retain an individual’s
social history, medical history, evaluations, and any court-related documentation for a
period of not less than 6 years after termination of services.
(f) For those receiving medicaid home- and
community-based care services, the record shall additionally contain, as
applicable, a copy of:
(1) The individual’s current service agreement;
(2) All service agreement amendments;
(3) Progress
notes on goals and support services provided as identified in the service
agreement;
(4) All service coordination contact notes and
quarterly assessments pursuant to He-M 522.11(m)(2)-(4); and
(5)
Evaluations and reviews by providers and professionals.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18; ss by #12683, eff 11-30-18 (formerly He-M 522.13)
He-M
522.13 Record Requirements for Provider Agencies.
(a)
Provider agencies shall maintain a separate record for each individual
who receives medicaid home-
and community-based care services and ensure the confidentiality of
information pertaining to the individual, including:
(1) Maintaining the confidentiality of any
personal data in the records;
(2) Storing and disposing of records in a manner
that preserves confidentiality; and
(3) Obtaining a release of information pursuant
to He-M 522.04(e) prior to release of any
part of a record to a third party.
(b)
An individual’s record shall include:
(1) Personal and identifying information including
the individual’s:
a. Name;
b. Address;
c. Date of birth; and
d. Telephone number;
(2) Information about the individual that would
be essential in case of an emergency, including:
a. Name, address, and telephone number of legal guardian,
representative, next of kin, or other person to be notified;
b. Names, addresses, and telephone numbers of current service providers; and
c. Medical information, including:
1. Diagnosis(es);
2. Health history;
3. Current medications;
4. Allergies;
5. Do not resuscitate (DNR) orders, as
appropriate; and
6. Advance directives, as determined by the
individual;
(3) A copy of the individual’s current service
agreement;
(4) Copies of all service agreement amendments;
(5) Progress notes on goals and support services
provided as identified in the service agreement;
(6) Copies of evaluations and reviews by providers
and professionals that are relevant to the individual’s current needs;
(7) Copies of correspondence within the past year
with the individual and guardian, service providers, physicians, attorneys,
state and federal agencies, family members, and others in the individual’s life;
(8) Any correspondence involving the individual
and the provider agency; and
(9) Information about transfer or termination of
services, as appropriate.
(c)
All entries made into an individual record shall be legible, dated, and
have the author identified by name and position.
(d)
In addition to the documentation requirements identified in He-M 522, each provider agency
shall comply with all applicable documentation requirements of other department
rules.
(e)
Each provider agency shall:
(1) Retain records supporting each medicaid bill
for a period of not less than 6 years; and
(2) Retain an individual’s social history,
medical history, evaluations,
and any court-related documentation for a period of not less than 6 years after
termination of services.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18 (formerly He-M 522.14)
He-M 522.14
Allocation of Funds.
(a) For newly found
eligible adults, the period between the time of completion of a basic service
agreement and the allocation by the department of the funds needed to carry out
the services required by the service agreement shall not exceed 90 days.
(b) For individuals already receiving medicaid home- and community-based care services
who experience significant life changes as described in (i) below, the period
of time for initiation of new services shall not exceed 90 days from the amendment
of the service agreement except by mutual agreement between the area agency and
the individual specifying a time limited extension.
(c)
Allocation of funds shall be handled by the area agencies and the
department through the following processes:
(1) Wait list in compliance with (a) above;
(2) Electronic wait list registry database; and
(3) Advanced crisis funding.
(d) Each area agency shall maintain a wait list
for those individuals who
need and are ready to receive services currently but for whom funding is not available.
(e)
For individuals who are already receiving services, the area agency
shall place such individuals’ names on the wait list if:
(1) They require a different service; or
(2) Their status has changed.
(f)
The area agency shall document its wait list by entering the following
information into the electronic wait list registry database at
https://nhleads.org:
(1) Name and date of birth of the individual;
(2) The diagnosis
that identifies the individual’s acquired brain disorder pursuant to He-M
522.02(a);
(3) The individual’s category of service, identified
as either:
a. Developmental services;
b. Acquired brain disorder services; or
c. In-home support services;
(4) A brief description of the individual’s circumstances
and the reasons for the request;
(5) The type of services currently received, if
any;
(6) An initial cost estimate of the services
requested;
(7) The date by which services are needed;
(8) The date the individual’s name went on the wait
list;
(9) The date on which, and the reasons for which,
the individual’s name is taken off the wait list; and
(10) The date when the individual began to receive
the services for which his or her name had been put on the wait list.
(g)
To access the wait list funds appropriated for a given fiscal year, the
area agency shall complete the allocation module of the wait list registry by
prioritizing each individual’s urgency of need based on the following factors:
(1) Advanced age of the family caregiver;
(2) Advanced age of the individual;
(3) Declining
health of the family caregiver;
(4) Declining
health of the individual;
(5) Sole caregiver with no other supports in the
home;
(6) High work demands of the family caregiver;
(7) Family caregiver responsible for others in
the family needing care;
(8) Individual
with no day services while living with a family caregiver;
(9)
Individual’s low safety awareness;
(10)
Individual’s behavioral challenges;
(11)
Individual’s involvement in the legal system;
(12)
Individual living in or at risk of going to an institutional setting;
(13) Individual
needing long-term employment funding to maintain his or her job after completing
employment training;
(14) Significant regression in individual’s overall
skills such that the individual’s level of independence is diminished; or
(15) Length
of time on the wait list as compared to others.
(h) In completing the wait list registry the area
agency shall exclude those circumstances where funds might be needed to cover
additional expenditures, such as cost-of-living or other wage and compensation
increases.
(i) An area agency shall request advanced
crisis funding from the department to provide services without delay when there
are no generic or area agency resources available and an individual is
experiencing a significant life change such that he or she is:
(1) A victim of abuse, neglect, or exploitation
pursuant to He-E 700 or He-M 202;
(2) Abandoned and homeless;
(3) Without a caregiver due to death or
incapacitation;
(4) At significant risk of physical or
psychological harm due to decline in his or her medical or behavioral status;
(5) Presenting a significant risk to community
safety; or
(6) In need of long-term employment funding to
maintain his or her employment.
(j) To demonstrate the need
for advanced crisis funding the area agency shall submit to the department, in
writing, a detailed description of the individual’s circumstances and needs, a
proposed budget, and the assessments and evaluations required by He-M 522.05(a)
and He-M 522.10(d).
(k) The department shall
review the information submitted by the area agency and approve advanced crisis
funding if it determines that one of the conditions cited in (i) above applies to the
individual’s situation and the individual’s name has been entered into the wait
list registry.
(l)
The department shall utilize funds from statewide individual vacancies
in order to finance services that are approved pursuant to (k) above.
(m) For each request an area agency makes for
funding individual services, the department shall make the final determination
on the cost effectiveness of proposed services.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18 (formerly He-M 522.15)
He-M 522.15
Transfers Across Regions.
(a)
If an individual, guardian, or representative
plans to relocate where the individual lives and
wishes to transfer the individual’s area
agency affiliation to that region, the individual, guardian, or representative
shall notify, in writing, the area agency in the current region and the area
agency in the proposed region that the individual
is moving and wishes to transfer services to that region.
(b)
The current area agency shall send to the proposed area agency all
information regarding the individual, including information concerning funding for
the individual’s services.
(c)
The current area agency shall transfer to the proposed area agency all
funds being spent for the individual’s services, including funds allocated for
administrative costs, with the exception of regional family support state
funds.
(d)
Service coordinators shall coordinate individual transfers so that benefits
obtained from third party resources such as medicaid and the division of
vocational rehabilitation shall not be lost or delayed during the transition
from one region to another.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff 11-30-18
(formerly He-M 522.16)
He-M 522.16 Termination of Services.
(a) If termination of
services is being considered by the area agency, individual, guardian, or
representative, then the service coordinator shall meet with either the
individual or his or her guardian or representative, or both, to discuss the reasons for
the recommended termination.
(b) Any recommendation for termination
shall be made in writing to the area agency director and be based on at least one of the
following:
(1) The individual can function without service(s); or
(2) Services are no longer necessary because they
have been replaced by other supports or services.
(c) Within 10 business days of receipt of a
recommendation for termination of services, an area agency director shall cause
a meeting of the service coordinator, either the individual or his or her
guardian or representative, or both, and the service provider(s) to be convened
to review the request. The purpose of
the meeting shall be to determine if either of the criteria listed in (b) above
applies to the individual.
(d)
Based on the information presented and determinations made at the
meeting, the service coordinator shall prepare a written report for the area
agency director which sets forth one of the following:
(1) A statement of concurrence with the
recommendation for termination;
(2) A recommendation for continuance; or
(3) Changes to the individual’s service
agreement.
(e)
The area agency director shall make the final decision regarding termination
based on the criteria listed in (b) above.
(f)
If a decision is made to terminate services pursuant to (e) above, the
area agency director shall send a termination notice to the individual, guardian,
or representative at least 30 days prior to the proposed termination date. Service may be terminated sooner than 30 days
with the consent of the individual, guardian, or representative. The individual, guardian, or representative
may appeal the termination decision in accordance with He-C 200.
(g)
In each termination notice the area agency shall provide information on
the reason for termination, the right to appeal, and the process for appealing
the decision, including the names, addresses, and phone numbers of the
department and advocacy organizations, such as the disability rights center-NH,
which the individual, guardian, or representative may contact for assistance in
appealing the decision.
(h)
An individual whose services have been terminated may request resumption
of services if he or she believes that the reasons for the termination of
services no longer apply. Such a request
shall be made by the individual, guardian, or representative, in writing, to
the area agency director.
(i)
Upon request of the individual, guardian, or representative, the area
agency director shall resume services to the individual if the criteria in (b)
above no longer apply and if funding is available.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff
10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10; ss by #12683, eff
11-30-18 (formerly He-M 522.17)
He-M
522.17 Voluntary Withdrawal from Services.
(a)
An individual, guardian, or representative may withdraw voluntarily from
any service(s) at any time, except as provided by RSA 171-B.
(b)
The administrator of the service from which withdrawal is made shall
notify the area agency in writing of the withdrawal and so indicate in the
individual’s record when such withdrawal was contrary to the individual’s
service agreement.
(c)
If service staff or a service coordinator for an individual determine
that withdrawal from a service might constitute abuse, neglect, or exploitation on the part
of a guardian or representative, the staff or service coordinator shall report such
abuse, neglect, or
exploitation as required by law.
(d)
If an individual does not have a guardian or representative and his or
her service coordinator or any other person believes that the individual is not
making an informed decision to withdraw from services and might suffer harm as
a result of abuse, neglect, or exploitation, the area agency shall pursue the
least restrictive protective means including, as appropriate, guardianship to
address the situation.
(e)
An individual who has withdrawn from services may request resumption of
services at any time. Such a request
shall be made by the individual, guardian, or representative, in writing, to
the area agency director.
(f)
Upon request of the individual, guardian, or representative, the area
agency director shall resume services to the individual if funding is
available.
Source. #9734, eff 6-25-10 (from He-M 522.13); ss by #12683,
eff 11-30-18(formerly He-M 522.18)
He-M
522.18 Challenges and Appeals.
(a) Any determination, action, or inaction by
an area agency may be appealed by an individual, guardian, or representative.
(b)
An individual, guardian, or representative may choose to pursue formal
or informal resolution to resolve any disagreement with an area agency. If informal resolution is sought, at any time
during the process or within 30 business days of the area agency decision, she
or he may choose to file a formal appeal pursuant to (e)-(g) below. All formal appeals shall be filed within 30
business days of the area agency determination, action, or inaction.
(c) The following actions shall
be subject to the notification requirements of (d) below:
(1) Adverse
eligibility actions under He-M 522.05(d) and
(l), He-M 522.06(a), and He-M 522.07(b);
(2) Area agency determinations regarding an
individual’s, guardian’s, or representative’s selection of provider under He-M 522.08(e) or removal of
provider under He-M 522.08(f);
(3) Area agency
determinations regarding the removal of an individual, guardian, or
representative’s selected service coordinator under He-M 522.09(f)(2) and (3); or
(4) A determination to terminate services under
He-M 522.16(e).
(d) An area agency shall provide written and verbal
notice to the applicant and guardian or representative of the actions specified
in (c) above, including:
(1) The specific facts and rules that support, or
the federal or state law that requires, the action;
(2) Notice of the individual’s right to appeal in
accordance with He-C 200 within 30 business days and the process for filing an
appeal, including the contact information to initiate the appeal with the
department;
(3) Notice of the individual’s continued right to
services pending appeal, when applicable, pursuant to (g) below;
(4) Notice of the right to have representation with
an appeal by:
a. Legal counsel;
b. A relative;
c. A friend; or
d. Another spokesperson;
(5) Notice that neither the area
agency nor the bureau is responsible for the cost of representation; and
(6) Notice of organizations with their addresses
and phone numbers that might be available to provide pro bono or reduced fee
legal assistance and advocacy, including the disability rights center-NH.
(e) Appeals shall be forwarded, in writing, to
the bureau administrator in care of the department’s office of client and legal
services. An exception shall be that
appeals may be filed verbally if the individual is unable to convey the appeal
in writing.
(f)
The bureau administrator shall immediately forward the appeal to the
department’s administrative appeals unit which shall assign a presiding officer
to conduct a hearing or independent review, as provided in He-C 200. The burden shall be as provided by He-C 203.14.
(g)
If a hearing is requested, the following actions shall occur:
(1) Current recipients, services, and payments
shall be continued as a consequence of an appeal for a hearing until a decision
has been made; and
(2) If the department’s decision is upheld:
a. Benefits shall cease 60 days from the date of
the denial letter or 30 days from the hearing decision, whichever is later; or
b. In the instance of termination of services,
services shall cease one year after the initial decision to terminate services
or 30 days from the hearing decision, whichever is later.
Source. #9734, eff 6-25-10 (from He-M 522.14); ss by #12683,
eff 11-30-18 (formerly He-M 522.19)
He‑M 522.19 Waivers.
(a)
An applicant, area agency, provider agency, individual, guardian, representative, or provider may
request a waiver of specific procedures outlined in He-M 522 by:
(1) Completing and submitting the form titled “NH
bureau of developmental services waiver request” (January 2018 edition). The area agency shall submit the request in
writing to the bureau administrator; and
(2) If a waiver request is made based on a
criminal record, a copy of the current criminal record, dated within a year of
when the waiver request is made.
(b)
A completed waiver request form shall be signed by:
(1) The individual, guardian, or representative
indicating agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c)
A waiver request shall be submitted to:
Department of Health and Human Services
Office of Client
and Legal Services
Hugh J. Gallen
State Office Park
105 Pleasant Street,
Main Building
Concord, NH 03301
(d)
No provision or procedure prescribed by statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner within 30
days if the alternative proposed by the requesting entity meets the objective
or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not affect the quality of services to
individuals.
(f)
Upon receipt of approval of a waiver request, the requesting entity’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(g)
Waivers shall be granted in writing for a specific duration not to
exceed 5 years.
(h)
Any waiver shall end with the closure of the related program or service.
(i) A requesting entity may request a renewal
of a waiver from the department. Such request shall be made at least 90 days
prior to the expiration of a current waiver.
Source. #9734, eff 6-25-10 (from He-M 522.15); ss by
#12683, eff 11-30-18 (formerly He-M 522.20)
PART He-M 523 FAMILY SUPPORT SERVICES TO CHILDREN AND YOUNG
ADULTS WITH CHRONIC HEALTH CONDITIONS
Statutory
Authority: RSA 161:4-a, IX
REVISION NOTE:
Document #13370, effective 4-20-22, readopted
with amendments the form “Special Medical Services (SMS)—Application for All
Services” and re-named the form “Bureau for Family
Centered Services (BFCS)—Application for Services” pursuant to the expedited
revisions to agency forms process in RSA 541-A:19-c. Document #13370 updated the revision date on the
form from “(December 2018)” to “(4/2022)”.
The form is incorporated by reference in He-M 520.02(a) and He-M 523.04(a)(1). Document #13370 contained only the amended
form, giving it a new effective date of 4-20-22. The prior filing affecting rule He-M 520.02 was
Document #12699, effective 12-28-18, and the prior filing affecting rule He-M
523.04 was Document #12700, effective 12-28-18, although the revision date for
the form in the rules was “(August, 2018).”
The effective date of the rules remained unchanged by Document #13370.
Document #13696, effective 7-22-23, readopted
with amendments the form “Bureau for Family Centered Services (BFCS)—Application
for Services” pursuant to the expedited revisions to agency forms process in
RSA 541-A:19-c. Document #13696 updated
the revision date on the form from “(4/2022)” to “(July 2023)”. The form is still incorporated by reference
in He-M 520.02(a) and He-M 523.04(a)(1).
Document #13696 contained only the amended form, giving it a new
effective date of 7-22-23. Since Document #13696 updated the revision date
on the form from “(4/2022)” to “(July 2023)”, the revision date was subsequently
updated editorially in He-M 520.02(a) and He-M 523.04(a)(1) from “(August 2018)”
to “(July 2023)”. The effective date of
the rules remained unchanged by Document #13696.
He-M 523.01 Purpose.
(a)
The purpose of these rules is to establish a framework that provides
supports for the needs of young adults and families who have a child with a
chronic health condition. This framework
will allow decisions regarding family support services to be made with
consideration for the unique needs and characteristics of each young adult and
family.
(b)
As each young adult’s and family’s circumstances and needs vary, the
purpose of family support services is to assist young adults and families of
children with chronic health conditions to advocate, access resources, navigate
systems, and build competence to manage their own or their children’s chronic
illnesses through family directed education, support, and encouragement.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18
He-M 523.02 Definitions.
(a)
“Action plan” means a written plan for providing supports and services
to an eligible young adult or family.
(b)
“Applicant” means the person for whom the application is made.
(c) “Bureau” means the bureau of special medical services of the department of
health and human services.
(d) “Bureau administrator” means the chief
administrator of the bureau of special
medical services.
(e)
“Chronic health condition” means a physical condition that:
(1) Will last or is expected to last for 12
months or longer;
(2) Meets one or both of the following criteria:
a. Consistently affects the individual’s ability
to function on a daily basis:
1.
In the areas of emotional, social, or physical development; or
2.
In his or her family, school, or community; or
b. Requires more intensive medical care from
primary care and specialty providers than is typically required for well child
and acute illness visits; and
(3)
Is not excluded
pursuant to He-M 523.03 (c).
(f)
“Department” means the New Hampshire department of health and human
services.
(g)
“Family” means the biological, adoptive, or foster parents, or legal
guardians of a child aged 0 through 20 who has a chronic health condition.
(h)
“Family support services” means those activities and interventions that:
(1) Are identified by a young adult or family in
the action plan;
(2)
Are provided for, or on behalf of, that young adult or family through
the PIH family council, the PIH coordinator, SMS, or the lead agency; and
(3) Assist that young adult or family as primary
caregiver of a child with a chronic health condition.
(i)
“Lead agency” means an entity awarded a contract by special medical
services to provide Partners in Health services to young adults and families
living in a designated region.
(j) “Partners in Health” (PIH) means a
New Hampshire community-based program of family support for young adults and
families.
(k) “Special medical services (SMS)”
means the bureau of special medical services that administers Partners In
Health.
(l)
“Young adult” means a person who has a chronic health condition and is
eligible for services described in He-M 523.05, and is:
(1) 18 through 20 years of age; or
(2) A minor who has been legally emancipated.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18
He-M 523.03 Eligibility.
(a)
An applicant shall be eligible for services described in He-M 523.06 if
the applicant is a family as defined in He-M 523.02(g) or a young adult as
defined in He-M 523.02(l).
(b)
For the purposes of establishing eligibility, an applicant shall provide
documentation from a licensed physician, advanced practice registered nurse, or
doctor of osteopathy indicating that the person’s chronic health condition
meets the specific criteria in He-M 523.02(e).
(c) An applicant who meets the criteria of a chronic
health condition as defined in He-M 523.02(e) shall not be eligible to receive
services under He-M 523 if the condition is:
(1) A developmental disability when:
a. The
disability meets the definition in RSA 171-A:2, V; and
b. The person would be or has been found
eligible for services pursuant to He-M 503.03 through He-M 503.18;
(2) A mental illness when the illness:
a. Meets the definition in RSA 135-C:2, X; or
b. Meets the definition of serious emotional
disturbance in He-M 401.02 (u);
(3) A dental condition; or
(4) Obesity, which means a body mass index equal
to or greater than the gender- and age-specific 95th percentile from the Centers
for Disease Control and Prevention growth charts.
(d) A young adult or
family shall receive family support services from the region in which they
reside.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18
He-M 523.04 Application Procedure.
(a)
An application for services shall include:
(1) A fully
completed and signed “Special Medical Services (SMS) – Application for All
Services” (July 2023 Edition); and
(2) A fully executed release to obtain medical
records from the applicant’s physician, to confirm a chronic health condition.
(b)
Within 60 days of the date of
application, PIH shall:
(1) Accept and review all applications for
program eligibility, in accordance with He-M 523.05;
(2) Notify the applicant in writing of the
applicant’s eligibility status and the services for which the applicant is
eligible; and
(3) Have the applicable Family Support
Coordinator initiate phone contact to discuss the PIH program for which the
applicant has been found eligible.
(c)
PIH’s notice of decision shall include:
(1) For eligibility approvals:
a. The beginning
and ending dates of PIH eligibility;
b. The name and phone number of a PIH contact person;
and
c. Notice that
the recipient shall report to PIH any change in the recipient’s medical insurance
coverage, including Medicaid or TPL changes, within 30 days of the change; and
(2) For eligibility denials:
a. The reason(s) for denial;
b. Information about the applicant’s right to an
appeal in accordance with He-M 202 and He-C 200; and
c. Alternate
support services information as available.
(d)
For an applicant who is determined to be eligible, eligibility shall be
effective for 12 months from the applicant’s application date, except when any
changes affect the recipient’s eligibility status.
(e)
PIH shall notify a recipient in writing 30 calendar days prior to the
date that eligibility will close, for such reasons as the 12-month eligibility
period is expiring, the recipient is turning 21, services provided are no
longer available, or there is a change which affects eligibility status.
(f)
A new application shall be submitted in accordance with (a) above prior
to the expiration of current eligibility.
(g)
An applicant or recipient shall have the right to reapply at any time
after eligibility has been denied.
(h)
An applicant who submits false or misleading information shall be
subject to the provisions of RSA 132:15 and RSA 638:15.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18
He-M 523. 05 Determination of Eligibility.
(a)
The medical documentation provided pursuant to He-M 523.03 (b), and any
other information provided by the applicant concerning the applicant’s
unconfirmed chronic health condition, shall be the basis for determination of
eligibility for services.
(b)
A PIH coordinator shall review the medical documentation received
regarding an applicant and, within 15 business days after the receipt of the
documentation, confirm the applicant has a chronic health condition as defined
by He-M 523.02(e).
(c)
In cases where the information regarding eligibility is inconclusive, a SMS
clinician shall make the determination of an applicant’s eligibility.
(d)
If the information required to determine eligibility cannot be obtained
or it is anticipated that the person will not be determined eligible in
consultation with SMS within the timelines stated in (b) above, the PIH
coordinator shall:
(1) Request an extension from the applicant, in
writing, stating the reason for the delay; and
(2) Obtain the approval in writing from the
applicant.
(e) Extensions approved in writing by the
applicant in (d) above shall not exceed 30 business days after the receipt of
the documentation.
(f)
If the PIH coordinator’s request for an extension pursuant to (d) above
is denied by the applicant, the PIH coordinator shall determine the applicant
to be ineligible for services. The young
adult or family may reapply for services pursuant to (k) below.
(g) The PIH coordinator shall
authorize services to be provided prior to the completion of the eligibility
determination process if such services are necessary to protect the health or
safety of an applicant who the PIH coordinator believes is likely to be
eligible, based upon available information.
(h)
Within 5 business days of the determination of a family’s or a young adult’s
eligibility, a PIH coordinator shall send notice to each applicant that
includes the determination of eligibility.
(i)
Preliminary planning to determine the services needed shall occur with
the young adult or family when the application is submitted or no later than 5 business
days from the notification of eligibility.
(j)
Within 5 business days of determination of an applicant’s ineligibility,
a PIH coordinator shall convey to the applicant a written decision that
describes the specific legal and factual basis for the denial, including
specific citation of the applicable law or department rule, and advise the
applicant in writing and verbally of the appeal rights under He-M 523.13.
(k)
Following denial of eligibility, the individual or family, as
applicable, may reapply for services if new information regarding the diagnosis
or about the health condition becomes available or if the timelines are not met
in accordance with (f) above.
(l)
The determination of eligibility by one PIH coordinator shall be
accepted by every lead agency of the state.
(m)
On an annual basis, the PIH coordinator shall re-determine the
eligibility of a young adult or family through the review of the young adult’s
or family’s action plan.
(n)
Young adults and families shall make the necessary medical and other forms
of documentation concerning the chronic health condition available upon request
from the PIH coordinator, SMS or the lead agency.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.04)
He-M 523.06 Family Support Services.
(a)
Family support services shall:
(1) Assist young adults to identify and assess
their own strengths, needs, and goals;
(2) Assist families to identify and assess the
care of their children who have chronic health conditions;
(3) Aid young adults to care for their chronic
health conditions;
(4) Aid families to care for their children who
have chronic health conditions;
(5) Assist young adults to access the financial,
educational, training, and other resources and services needed to monitor, assess,
and respond to their own health care needs;
(6) Assist families to access the financial,
educational, training, and other resources and services needed to monitor,
assess, and respond to their children’s chronic health condition; and
(7) Assist young adults and families in obtaining
services such as applying for grants and locating donations of goods.
(b)
Family support services shall include financial assistance based on the
young adult’s or family’s needs and the availability of funds.
(c)
The PIH family council shall establish the method of provision of
financial assistance, including limits on the use of PIH family support services
funding, in accordance with He-M 523.08.
Source. #7713, eff 6-21-02; ss by #97278, eff
6-18-10; ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.05)
He-M 523.07 Responsibilities of Lead Agency.
(a)
Each lead agency shall:
(1) Have a contract with SMS to provide PIH
services within a designated region(s);
(2) Provide community outreach and education to
promote PIH throughout the region(s);
(3) Review PIH services to ensure that services are
provided to a young adult or family in home and community settings and are
based on a young adult’s or family’s needs, interest, competencies, and
lifestyles; and
(4) Designate, with input from the family council,
a PIH coordinator(s) for each designated region, but a person may serve as a
coordinator for more than one region.
(b)
The lead agency shall comply with SMS quality assurance activities,
including:
(1) Conducting and reviewing member satisfaction surveys;
(2) Reviewing personnel files of any staff funded
through the contract for completeness; and
(3) Participating in quality improvement reviews
conducted by the SMS including:
a. Reviewing the records of young adults and families;
and
b. Reviewing the lead agency’s compliance with
this section.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.06)
He-M 523.08 PIH Family Council.
(a)
Each region shall have a PIH family council that shall act as an advisory
body to the lead agency.
(b)
A regional PIH family council shall:
(1) Be composed of a minimum of 5 members;
(2) Have members who are, or have been, young
adults or family members enrolled in PIH; and
(3) Neither the Family Support Coordinator nor
the Lead Agency Supervisor may be a voting member of the council.
(c)
Each regional PIH family council shall establish and maintain policies
that address, at a minimum, the following:
(1) Membership, recruitment, rotation, and term
limits for service on the council;
(2) A process for determining the chairperson and
other officers;
(3) Providing all PIH family council members
orientation, training, and mentorship; and
(4) Processes used to determine the utilization
of funds and other resources identified for family council activities.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRES: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.07)
He-M 523.09 Collaboration Between Lead Agencies and
PIH Family Councils.
(a)
Lead agencies and PIH family councils shall work together to support the
mission of the PIH program by coordinating planning activities with one
another, and with other community agencies, to maximize supports, services, and
funding.
(b)
Specifically, lead agencies and PIH family councils shall work collaboratively
to:
(1) Determine and agree upon the 2 parties’
relationship, roles, and responsibilities;
(2) Develop and agree upon a method of conflict
resolution, including the provision that in cases of without resolution SMS
shall be the final arbiter regarding He-M 523 applicability; and
(3) Develop and implement a biennial regional
family support plan.
(c)
At a minimum, the regional family support plan for each region shall:
(1) Specify the methods used to identify needs of
young adults and families in the region;
(2) Identify the needs of young adults and
families residing in the region;
(3) Identify the resources available to support
young adults and families in the region;
(4) Identify
community agencies that serve children and young adults with chronic health
conditions;
(5) Prioritize identified needs based on the
information obtained in (1) through (4) above; and
(6) Develop strategies to address priorities.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.08)
He-M 523.10 PIH Coordinator Duties and Qualifications.
(a)
Each lead agency shall have at least one person designated as a PIH
coordinator.
(b)
A PIH coordinator’s duties and qualifications shall be identified by a
job description designed jointly by the PIH family council and lead agency and
in accordance with (c) and (d) below.
(c)
A PIH coordinator shall have at least an associate's degree from an
accredited program in a field of study related to health or social services
with at least one year's corresponding experience.
(d)
A PIH coordinator shall:
(1) Review and communicate eligibility for services
to applicants as specified in He-M 523.03 and He-M 523.04;
(2) Provide, or assist young adults and families
in acquiring, family support services;
(3) Coordinate the establishment and operations
of the PIH family council;
(4) Provide information to the PIH family council
regarding family supports to assist the council to:
a. Understand young adults’ and families’ needs;
b. Act on those needs; and
c. Monitor the services and supports provided;
(5) Provide information
and referral consultation to those staff providing family support under He-M
519, upon request of the area agency family support coordinator, or the
young adult or family;
(6) When distributing funds, ensure that a young
adult or family has accessed all other available funding and community
resources prior to receiving family support services funding, and consider the
following:
a. The unique needs of each young adult or
family related to their chronic health condition;
b. Maintenance of sufficient funds in a given
budget cycle; and
c. The needs within the region, as established
by the regional family support plan in He-M 523.09(c);
(7) Solicit financial support for young adults
and families from community groups, foundations, and other sources to augment
state funding as needed;
(8) Develop an action plan with each young adult
and family that includes:
a. A young adult or family profile; and
b. A prioritization of needs and goals to be
addressed, including:
1. Timelines;
2. Methods for achieving goals; and
3. Criteria for completion; and
c. Planning for health care transitions;
(9) Maintain records regarding supports and services
provided for young adults and families; and
(10) Facilitate the distribution of family support
funds under the direction of the PIH family council.
(e) Family support services provided by the PIH
coordinator shall:
(1) Be initiated through an action plan;
(2) Include the following:
a. Documentation of all contacts with the child,
his or her family, or the young adult; and
b. Determination of the young adult’s or the
family’s satisfaction with services; and
(3) Involve coordination and monitoring of family
support services.
(f) A PIH coordinator shall assist a young adult
and family to access other appropriate and available community resources prior
to using PIH family support services funds.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10
(from He-M 523.11); ss by #12559, INTERIM, eff 6-26-18, EXPIRES: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.09)
He-M 523.11 Voluntary Withdrawal from Services.
(a)
A young adult or family may withdraw voluntarily from services at any
time.
(b)
The PIH coordinator shall document the withdrawal in the record.
(c)
A young adult or family who has withdrawn from services may reapply for
services at any time.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10);
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.10)
He-M 523.12 Designation of Region Boundaries.
(a)
An eligible young adult or family may request to SMS to receive services
from a region other than the one in which they reside.
(b) A lead agency
may request from SMS, with the approval of the eligible young adult or family,
that the young adult or family receive services from another region other than the
one in which they reside.
(c)
Requests made in (a) and (b) above shall be submitted in writing to SMS
and include supporting information that explains why the family is better
served by another region.
(d)
A lead agency shall be awarded a contract to service one or more of the
regions listed in Table 523-1:
Table 523-1, TOWNS
AND CITIES BY REGION
Region I |
|||
|
|
|
|
Albany |
Easton |
Livermore |
Stratford |
Bartlett |
Eaton |
Lyman |
Sugar
Hill |
Bath |
Effingham |
Madison |
Tamworth |
Benton |
Errol |
Milan |
Tuftonboro |
Berlin |
Franconia |
Millsfield |
Union |
Bethlehem |
Freedom |
Monroe
|
Wakefield |
Brookfield |
Gorham |
Moultonboro |
Warren |
Carroll |
Groveton |
Northumberland |
Waterville |
Chatham |
Hart's Location |
Ossipee |
Wentworth |
Clarksville |
Haverhill |
Piermont |
Whitefield |
Colebrook |
Jackson |
Pittsburg |
Wolfeboro |
Columbia |
Jefferson |
Randolph |
Woodstock |
Conway |
Lancaster |
Sanbornville |
Woodsville |
Dalton |
Landaff |
Sandwich |
|
Dixville |
Lincoln |
Shelburne |
|
Dummer |
Lisbon |
Stark |
|
|
Littleton |
Stewartstown |
|
|
|
|
|
Region II |
|||
|
|
|
|
Acworth |
Dorchester |
Langdon |
Orford |
Canaan |
Enfield |
Lebanon |
Plainfield |
Charlestown |
Goshen |
Lempster |
Springfield |
Claremont |
Grafton |
Lyme |
Sunapee |
Cornish |
Grantham |
Newport |
Unity |
Croydon |
Hanover |
Orange |
Washington |
|
|
|
|
Region
III |
|||
|
|
|
|
Alexandria |
Bristol |
Groton |
Plymouth |
Alton |
Campton |
Hebron |
Rumney |
Ashland |
Center Harbor |
Holderness |
Sanbornton |
Barnstead |
Ellsworth |
Laconia |
Thornton |
Belmont |
Gilford |
Meredith |
Tilton |
Bridgewater |
Gilmanton |
New Hampton |
|
Region
IV |
|||
|
|
|
|
Allenstown |
Dunbarton |
Hopkinton |
Sutton |
Andover |
Danbury |
Loudon |
Warner |
Boscawen |
Deering |
Newbury |
Weare |
Bow |
Epsom |
New London |
Webster |
Bradford |
Franklin |
Northfield |
Wilmot |
Canterbury |
Henniker |
Pembroke |
Windsor |
Chichester |
Hill |
Pittsfield |
|
Concord |
Hillsboro |
Salisbury |
|
|
|
|
|
Region V |
|||
|
|
|
|
Alstead |
Greenville |
Nelson |
Surry |
Antrim |
Hancock |
New Ipswich |
Swanzey |
Bennington |
Harrisville |
Peterborough |
Temple |
Chesterfield |
Hinsdale |
Richmond |
Troy |
Dublin |
Jaffrey |
Rindge |
Walpole |
Fitzwilliam |
Keene |
Roxbury |
Westmoreland |
Francestown |
Lyndeborough |
Sharon |
Winchester |
Gilsum |
Marlborough |
Stoddard |
|
Greenfield |
Marlow |
Sullivan |
|
|
|
|
|
Region VI |
|||
|
|
|
|
Amherst |
Hudson |
Merrimack |
Nashua |
Brookline |
Litchfield |
Milford |
Wilton |
Hollis |
Mason |
Mont Vernon |
|
|
|
|
|
Region
VII |
|||
|
|
|
|
Auburn |
Candia |
Hooksett |
Manchester |
Bedford |
Goffstown |
Londonderry |
New Boston |
|
|
|
|
Region
VIII |
|||
|
|
|
|
Brentwood |
Greenland |
Newfields |
Portsmouth |
Deerfield |
Hampton |
Newington |
Raymond |
East Kingston |
Hampton Falls |
Newmarket |
Rye |
Epping |
Kensington |
North Hampton |
Seabrook |
Exeter |
Kingston |
Northwood |
South Hampton |
Fremont |
New Castle |
Nottingham |
Stratham |
|
|
|
|
Region IX |
|||
|
|
|
|
Barrington |
Lee |
New Durham |
Strafford |
Dover |
Madbury |
Rochester |
|
Durham |
Middleton |
Rollinsford |
|
Farmington |
Milton |
Somersworth |
|
|
|
|
|
Region X |
|||
|
|
|
|
Atkinson |
Derry |
Pelham |
Sandown |
Chester |
Hampstead |
Plaistow |
Windham |
Danville |
Newton |
Salem |
|
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10;
ss by #12559, INTERIM, eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28-18 (formerly He-M 523.11)
He-M 523.13 Appeals.
(a)
Pursuant to He-M 202 or He-C 200, a young adult or family may choose to
pursue informal resolution to resolve any disagreement with a lead agency or,
within 30 business days of a lead agency decision, may choose to file an appeal.
(b) A young adult
or family may appeal any determination, action, or inaction by a lead agency.
(c) Appeals shall be submitted, in writing, to
the bureau administrator in care of the department’s office of client and legal
services.
(d) Appeals may be filed verbally, if the family
or young adult is unable to convey the appeal in writing.
(e)
The young adult or family may choose to participate in a hearing or
independent review, as provided in He-C 200.
The burden shall be as provided by He-C 203.14.
(f)
If a hearing is requested, the following actions shall occur:
(1) If the young adult or family is currently
receiving supports and services, those supports and services shall be continued
until a decision has been made;
(2) If the bureau’s decision is upheld, funding
shall cease 60 days from the date of the decision;
(3) If the young adult or family member is
appealing a denial of eligibility for supports and services, no family support
services shall be provided until a decision is made to reverse the denial; and
(4)
If the bureau’s decision if reversed, family support services shall commence as
soon as practicable.
Source. #9728, eff 6-18-10; ss by #12559, INTERIM,
eff 6-26-18, EXPIRED: 12-24-18
New. #12700, eff 12-28 18 (formerly He-M 523.12)
He‑M 523.14 Waivers.
(a)
A lead agency, PIH family council, family, or young adult may request a waiver
of specific procedures outlined in He-M 503 by completing and submitting to the
department, bureau of special medical services the form titled “Department of Health
and Human Services, Bureau of Special Medical Services Waiver for Services
(December 2018).”
(b)
A completed waiver request form shall be signed by the requester - young
adult, family, lead agency, or PIH family council representative.
(c)
The request for waiver shall be reviewed and granted by the commissioner
of the department or his or her designee, within 30 days of receipt of the request,
if the alternative proposed by the lead agency, PIH family council, family, or young
adult, meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the family or young adult(s); and
(2) Does not affect the quality of services to a
family or young adult.
(d) A waiver request shall be submitted to:
Department of
Health and Human Services
Special Medical
Services
State Office Park
South
129 Pleasant
Street, Thayer Building
Concord, NH 03301
(e)
No provision or procedure prescribed by statute shall be waived.
(f)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(g)
Waivers shall be granted in writing and remain in effect for the
duration of the service.
(h)
Any waiver shall end with the closure of the related program or service.
Source. #12700, eff 12-28 18 (formerly He-M 523.13)
PART He-M 524 IN-HOME SUPPORTS
Statutory Authority:
RSA 161-I:7; 171-A:3; 18, IV
He-M 524.01 Purpose. The purpose of these rules is to establish
minimum standards for the provision of Medicaid-covered home- and
community-based in home residential habilitation, including personal care and
other related supports and services that promote greater independence and skill
development for a child, adolescent, or young adult who:
(a)
Has a developmental disability;
(b)
Has significant medical or behavioral challenges as determined pursuant
to He-M 524.03 (a)(4) and (5) a.; and
(c)
Lives at home with his or her family.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
(a)
“Area agency” means “area agency” as defined under RSA 171-A: 2,
I-b, namely, “an entity established as a nonprofit corporation in the state of
New Hampshire which is established by rules adopted by the commissioner to
provide services to developmentally disabled persons in the area.”
(b)
“Bureau” means the bureau of developmental services of the department
of health and human services.
(c)
“Bureau administrator” means the chief administrator of the bureau
of developmental services.
(d) “Cultural competence” means the knowledge,
attitudes, and interpersonal skills applied to a provider’s practice methods that allow
the provider to understand, appreciate, and work effectively with individuals
from cultures other than his or her own.
(e)
“Department” means the New Hampshire department of health and
human services.
(f)
“Developmental disability” means “developmental disability” as defined
in RSA 171-A: 2, V, namely, “a disability:
(1) Which is attributable to intellectual
disability, cerebral palsy, epilepsy, autism or a specific learning disability or any other condition
of an individual found to be closely related to an intellectual disability as
it refers to general intellectual functioning or impairment in adaptive behavior
or requires treatment similar to that required for persons with an intellectual
disability; and
(2) Which originates before such individual
attains age 22, has continued or can be expected to continue indefinitely, and constitutes
a severe disability to such individual’s ability to function normally in
society.”
(g)
“Direct and manage” means to be actively involved in all chosen aspects
of the service arrangement, including but not limited to:
(1) Designing the services;
(2) Selecting the service providers;
(3) Deciding how the authorized funding is to be
spent based on the needs identified in the individual’s service agreement;
and
(4) Performing ongoing oversight of the services provided.
(h)
“Employer” means an area agency, subcontract agency, or person that
handles legally defined and other employer-related functions such as, but not
limited to:
(1) Paying employer taxes;
(2) Withholding employee taxes;
(3) Performing other payroll functions, including issuing paychecks;
(4) Providing workers’ benefits; and
(5) Obtaining workers’ compensation and liability insurance.
(i)
“Family” means a group of 2 or more persons related by ancestry,
marriage, or other legal arrangement, including foster care as defined in 45
C.F.R. § 1355.20, that has at least one member who has a developmental disability.
(j)“Guardian” means a person appointed
pursuant to RSA 547-B, RSA 463, or RSA 464-A or the parent of a child under the
age of 18 whose parental rights have not been terminated or limited by law.
(k)
“Home- and community-based care waiver” means a waiver pursuant
to the authority of section 1915 (c) of the Social Security Act which allows
the federal funding of long-term care services in non-institutional settings
for persons who are elderly, disabled, or chronically ill.
(l)
“In-home supports” means an array of home and community-based care
waiver services provided to an individual and his or her family in the home and
in the community to enhance the family’s and other caregivers’ ability to care for the
individual and to provide the individual with opportunities to develop a
variety of life skills as listed in He-M 524.05.
(m)
“Individual” means a child, adolescent, or young adult with a
developmental disability who is eligible to receive services pursuant to He-M
503.03 if aged 3 to 21 or pursuant to He-M 510 if under the age of 3.
(n)
“Individualized family support plan (IFSP)” means a written plan for
providing services and supports to a child and his or her family who are eligible for family-centered
early supports and services under He-M 510.06.
(o)
“Informed decision” means “informed decision” as defined in RSA 171-A:2,
XI, namely, “a choice made by a client or potential client or, where appropriate, his legal
guardian that is reasonably certain to have been made subsequent to a rational
consideration on his part of the advantages and disadvantages of each course of
action open to him.”
(p)
“Medicaid” means the federal medical assistance program established
pursuant to Title XIX of the Social Security Act.
(q)
“Nursing-related tasks” means those services that are delegated by
a licensed nurse to unlicensed personnel in accordance with RSA 326-B and Nur
Part 404.
(r)
“Parent” means an individual’s:
(1) Mother;
(2) Father;
(3) Adoptive mother;
(4) Adoptive father; or
(5) Legal guardian(s).
(s)
“Provider” means a person receiving any form of remuneration for the
provision of services to an individual.
(t)
“Representative” means, where applicable:
(1) The parent or legal guardian of an individual under the age of 18;
(2) The legal guardian of an individual 18 or over;
(3) A person who has power of attorney for the individual; or
(4) The division of children youth and families (DCYF) in cases where DCYF
has responsibility for the placement and care of an individual.
(u)
“Respite services” means the provision of short-term care, in accordance
with He-M 513, for an individual in or out of the individual’s home for the
temporary relief and support of the individual’s family.
(v)
“Service” means any paid assistance to the individual and his or
her family.
(w)
“Service agreement” means “individual service agreement” as defined in
RSA 171-A:2, X, namely, “a written document for a client's services and supports
which is specifically tailored to meet the needs of each client.”
(x)
“Service coordinator” means a person who meets the criteria in He-M
503.08(e) – (f) and is chosen or approved by an individual and his or her
guardian or representative, if applicable, and designated to organize,
facilitate, and document service planning and to negotiate and monitor the provision
of the individual’s services and who is:
(1) An area agency service coordinator, family
support coordinator, or any other area agency or subcontract agency employee;
(2) A friend of the individual; or
(3) Any other person chosen by the individual or representative who is
not a spouse, parent, relative, or guardian of the individual.
(y)
“Staff” means a person employed by an area agency, subcontract
agency, or other employer.
(z)
“Subcontract agency” means an entity that is under contract with any
area agency to provide services to individuals who have a
developmental disability.
(aa)
“Team” means the group of people that participates in service planning
meetings and includes the individual and his or her service coordinator and
representative, if applicable, and others invited by the individual.
Source. #7891, eff 5-20-03; amd by #9122, eff 4-3-08;
amd by #9927, INTERIM, eff 5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11;
ss by #13397, eff 6-18-22
He-M 524.03 Eligibility.
(a) In-home supports
shall be available to any individual birth through the age of 21 who lives at
home with his or her family, and who:
(1) Is found eligible for
services by an area agency pursuant to:
a. He-M 503.05 for individuals aged 3 to 21; or
b. He-M 510 for
individuals under the age of 3;
(2) Is found eligible for Medicaid
by the department pursuant to applicable rules in He-W 600 and He-W 800;
(3) Has not graduated or
exited the school system;
(4) Has 2 or more factors
specific to the individual or a combination of at least one factor specific to
the individual and one factor specific to the parent which complicate care of
the individual or impede the ability of the care-giving parent to provide care,
including:
a. The following
factors specific to the individual:
1. Lack of age
appropriate awareness of safety issues so that constant supervision is
required;
2. Destructive or injurious
behavior to self or others;
3. Inconsistent
sleeping patterns or sleeping less than 6 hours per night and requiring
supervision when awake; or
4. Any other condition
that impedes the ability of the:
(i) Care-giving parent to
provide care; or
(ii) Individual to
participate in local community childcare or activity programs without
support(s); or
b. The following
factors specific to the parent:
1. Care responsibilities
for other family members with disabilities or health problems;
2. Age of either parent being less than 18 years
or above 59;
3. Physical or
mental health condition which impedes the ability of the care-giving parent to
provide care;
4 Founded child
neglect or abuse as determined by a district court pursuant to RSA 169-C:21; or
5. Availability of only one parent for
care-giving; and
(5) Is determined by the
department to meet institutional level of care as demonstrated by requiring one
of the following:
a. Services on a
daily basis for:
1. Performance of
basic living skills;
2. Intellectual, communicative, behavioral,
physical, sensory motor, psychosocial, or emotional development and well-being;
3. Medication administration; or
4. Medical monitoring or nursing
care by a licensed professional person such as:
(i) A registered nurse;
(ii) A licensed practical nurse;
(iii) A physical therapist;
(iv) An occupational therapist;
(v) A speech pathologist;
or
(vi) An audiologist; or
b. Services on a less than daily basis as part
of a planned transition to more independence or to prevent circumstances that could necessitate more intrusive and costly services.
(b) To obtain
determination of home and community based services waiver eligibility, in addition
to the eligibility letter pursuant to He-M 503.05 or 510, the area agency shall
complete and submit to the bureau a “NH Bureau
of Developmental Services Functional Screen for Waiver Services” form (May
2013) and a “Bureau of Developmental Services In-Home
Supports Waiver Individual/Parent Factors Form” (April 2022) within 3 business
days of the eligibility determination made in accordance with He-M 524.03(a)(1)-(4)
above.
(c) A person shall not
be eligible for services under He-M 524 if he or she is:
(1) Not living with his or
her family; or
(2) Receiving services
under another home and community based Medicaid waiver.
(d) The bureau shall
deny in-home supports if it determines that the provision of services will
result in the loss of federal financial participation for such services.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.04 Provisions
Applicable to All Services.
(a) All in-home
supports shall be directed and managed by the individual or the individual’s
representative.
(b) In-home supports
shall be:
(1) Specifically tailored
to the competencies, interests, preferences, and needs of the individual and
his or her family and respectful of the cultural and ethnic beliefs,
traditions, personal values, and lifestyle of the family;
(2) Designed to facilitate,
maintain, and enhance supports from family members, friends, neighbors, child
care organizations, religious organizations, and community programs;
(3) Responsive to the
individual’s and family’s changing needs and choices within the limitations of
federal and state laws and rules;
(4) Specified in the
individual’s service agreement, or individual family support plan (IFSP);
(5) Provided only after the
informed consent of the individual or representative;
(6) In compliance with the
rights of the individual established under RSA 171-A:14 and He-M 310;
(7) Supportive of the
individual’s or representative’s efforts to direct and manage the services to
be provided; and
(8) Delivered in
collaboration with other related support plans when applicable, and consistent with
other services provided in additional environments such as the community, school,
and work.
(c) The individual
and the individual’s representative shall have free choice of any willing provider
meeting the qualifications of this part.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.05 In Home Residential Habilitation. In home residential habilitation services are
services that assist an individual with the acquisition, retention, or improvement
of skills related to living in the community, personal care, activities of
daily living (ADL), assistance with ADL’s, and community inclusion, including,
but not limited to, instruction and skill building to develop greater
independence in:
(a) Performing basic
living skills such as, but not limited to, eating, drinking, toileting,
personal hygiene, and dressing;
(b) Improving and
maintaining mobility and physical functioning;
(c) Maintaining
health and personal safety;
(d) Carrying out
household chores and preparation of snacks and meals;
(e) Communicating;
(f) Learning to make
choices, to show preferences, and to utilize opportunities for satisfying those
interests;
(g) Developing and
maintaining personal relationships;
(h) Participating in
community experiences and activities;
(i) Pursuing
interests and enhancing competencies in leisure and avocational activities; and
(j) Addressing
behavioral challenges.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.06 Service Coordination.
(a) Service coordination
services shall be services that assist individuals in gaining access to needed
waiver and or Medicaid State Plan services, as well as needed medical, social,
educational, and other services, regardless of funding source.
(b) Service
coordination services shall include the following:
(1) Coordinating,
facilitating, and monitoring services provided under He-M 524;
(2) Assessing and
re-assessing service needs, goals and outcomes;
(3) Facilitating development,
review, and modification of service agreements;
(4) Assisting with recruiting,
screening, hiring, and training providers;
(5) Identifying, providing
information about, and assisting families to access community resources;
(6) Providing counseling
and support;
(7) Providing advocacy
education and skill development to the individual, family, or his or her
representative;
(8) Initiating,
collaborating, and facilitating the development of a transition plan so that:
a. When the individual turns age 3, he or she
can access school services as described in He-M 510; and
b. When the individual graduates or exits the
school system, he or she can access adult supports, services, and community
resources with planning to start no later than age 16, or earlier if determined
necessary by the team in collaboration with the school district;
(9) Assisting in accessing
the registry of available providers and staff;
(10) Reviewing the actual
expenditures and revenues in the individualized budget and assisting the
individual or representative and providers in managing the authorized funds;
and
(11) Monitoring individual,
family, and representative satisfaction with services provided.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff 6-18-22
He-M 524.07 Consultative
Services.
(a) Consultative
services shall include any of the following services that are not otherwise
available under the Medicaid state plan, including but not limited to, Early
and Periodic Screening, Diagnostic and Treatment (EPSDT) under He-W 546,
benefits or services under the Rehabilitation Act of 1973, or the Individuals
with Disabilities Education Act:
(1) Evaluation, training,
mentoring, and special instruction to improve the ability of the service
provider, family, and other caregivers to understand and care for the individual’s
developmental, functional, health, and behavioral needs; and
(2) Support and counseling
regarding diagnosis and treatment of the individual to families for whom the
day-to-day responsibilities of caregiving have become overwhelming and
stressful.
(b) Consultative
services shall be limited to 100 hours per calendar year.
(c) The bureau
shall authorize consultative services exceeding 100 hours upon the written
recommendation of a licensed professional, the recommendation of the area
agency, and the availability of funds.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.08 Respite
Services.
(a) Respite services
shall be:
(1) The provision of short
term assistance, in or out of an individual’s home, for the temporary relief
and support of the family; and
(2) Provided pursuant to
He-M 513.
(b) Respite
services shall be limited to no more than 20% of an individual’s total budget.
(c) The cost of
training respite providers shall be outside of the total funds available for
respite.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.09 Environmental
and Vehicle Modification Services.
(a) Environmental
and vehicle modification services shall consist of physical adaptations to the
home environment of the individual or vehicle that is the primary means of
transportation of the individual that are necessary to ensure the health,
welfare, and safety of the individual or enable the individual to function with
greater independence in the home and community, and without which the individual
would require institutionalization.
(b) Adaptations to
the home environment shall include, but are not limited to the following:
(1) Installation of ramps
and grab-bars;
(2) Widening of doorways:
(3) Modification of
bathroom facilities; or
(4) Installation of specialized electric and plumbing systems,
which are necessary to accommodate the medical equipment and supplies, which
are necessary for the welfare of the individual.
(c) The following
shall not be included as environmental modifications:
(1) Adaptations or improvements to the home which are of general
utility and not of direct medical or remedial benefit to the individual, such
as, but not limited to, carpeting, roof repair, or central air conditioning;
and
(2) Adaptations that add to the total square footage of the home,
except when necessary to complete an adaption.
(d) The following
shall not be included as vehicle modifications:
(1) Adaptations that are of
general utility and not of direct medical or remedial benefit to the individual;
(2) The purchase or lease
of a vehicle; and
(3) Regularly scheduled
upkeep and maintenance, unless it is upkeep and maintenance of the modification.
(e) All modifications
shall be included in the individual’s service agreement.
(f) All home
modifications shall be made in accordance with all applicable State or local
building codes.
(g) For individuals
with unsafe wandering and running behaviors, outdoor fencing may be provided under
this waiver.
(h) Waiver funds allocated
toward the cost of the fence in (g) above shall not exceed $2,500 which can
provide approximately 3,500 square feet of a safe play area.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff 6-18-22
He-M 524.10 Assistive
Technology.
(a) “Assistive
technology” means an item, piece of equipment, certification and training of
service animal, or product system, used to increase, maintain, or improve
functional capabilities of an individual, including, but not limited to, the following:
(1) Devices, controls, or appliances, specified
in the individual service agreement that enable the individual
to increase their ability to perform activities of daily living, or perceive,
control, or communicate with the environment in which they live;
(2) The
evaluation of the assistive technology needs of an individual, including a
functional evaluation of the impact of the provision of appropriate assistive
technology and appropriate services to the individual;
(3) Purchasing,
leasing, or otherwise providing for the acquisition of assistive technology or
devices;
(4) Selecting,
designing, fitting, customizing, adapting, applying, maintaining, repairing, or
replacing assistive technology devices;
(5) Coordination
and use of necessary therapies, interventions, or services associated with other
services in the service agreement;
(6) Training or
technical assistance for the individual or the individual’s family members,
guardians, advocates, or authorized representatives;
(7) Training or
technical assistance for professional or other individuals who provide services
to, employ, or are otherwise substantially involved in the major life functions
of an individual; and
(8) Training and certification of a service
animal, defined in federal regulations implementing the Americans with Disabilities Act, 28 C.F.R. § 36.104 as
“service animal means any dog that
is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a
physical, sensory, psychiatric, intellectual, or other mental disability. Other species of animals, whether wild or domestic, trained
or untrained, are not service animals for the purposes of this definition.
The work or
tasks performed by a service animal must be directly related to the
individual's disability."
(b) “Adaptive
equipment” means items of durable and non-durable medical equipment necessary
to address the individual’s functional limitations.
(c) Adaptive
equipment shall not be covered if used for recreational purposes.
(d)
Payment for assistive technology shall be limited to $10,000 over the
course of 5 years.
(e)
The bureau shall authorize assistive technology in excess of the limitation in (d)
above upon written request which shall include documentation supporting the
need and the correlation of the request to the individual’s
service agreement.
(f) Assistive technology provided through the
home and community based services waiver shall be in addition to, and not
duplicative of, assistive technology which is available under the Medicaid state
plan, or that is the obligation of the individual's employer.
(g) In order to
obtain prior authorization for payment for assistive technology, the individual
service agreement (ISA) shall specify the following:
(1) The item;
(2) The name of the healthcare practitioner recommending
the item;
(3) An evaluation
or assessment regarding the appropriateness of the item;
(4) A goal related
to the use of the item;
(5) The anticipated
environment that the item will be used; and
(6) Current modifications to the item or product
and anticipated future modifications and anticipated cost.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.11
Community Integration Services.
(a)
Community integration services shall be services designed to support and
enhance an individual’s level of functioning,
independence and life activities, to promote health and wellness as well as
reduce or eliminate the activity limitations and restrictions to participation
in life situations caused by a disability shall include, but not be limited to
the following:
(1) Water safety training;
(2) Community
based camperships; and
(3) A pass or membership for admission to
community based activities only when needed to address assessed needs.
(b)
Community
based activity passes shall be purchased as day passes or monthly passes,
whichever is the most cost effective.
(c) Community integration services, inclusive of therapeutic
services and camperships, shall be capped annually at $8,000.
(d) Any single community integration service, other
than a campership, over $2,000 shall require a licensed healthcare practitioner’s
recommendation.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M
524.12 Individual Goods and Services.
(a) Individual goods
and services shall include equipment or supplies that address an identified
need in the ISA, and meet at least one of the following requirements:
(1) The good or service
decreases the need for other Medicaid services;
(2) The good or service
promotes inclusion in the community; or
(3) The good or service
increases the individual's safety in the home environment.
(b) Payment for individual
goods and services shall be made through the home and community based services
waiver if:
(1) The individual and
their family do not have the funds to purchase the item or service;
(2) The item or service is
not covered under the Medicaid State Plan; or
(3) The item or service is
not available through other sources.
(c) Payment for
experimental or prohibited treatments shall be prohibited.
(d) Payment for
individual goods and services shall not exceed $1,500 annually for an individual.
(e) The bureau shall authorize individual goods
and services in excess of the limitation in (d) above upon written request which shall include documentation supporting
the need and the correlation of the request to the individual’s service
agreement.
(f) Documentation
related to the use of the item shall be maintained in monthly progress notes in
accordance with He-M 524.24.
(g) Individual goods
and services shall have an anticipated finite period of time to be utilized.
(h) The frequency of
purchase of individual goods and services shall be determined in accordance
with the documented continued need of the item and the ability of the item to continue
to meet that need.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.13 Non-Medical Transportation.
(a)
Non-medical transportation services shall be services designed
specifically to improve the individual’s and the family caregiver's ability to
access community activities within their own community in response to needs identified through the individual's service agreement, including, but
not limited to:
(1) Orientation service using other services or supports for safe movement from one
place to another;
(2)
Travel training such as supporting the individual and family in learning
how to access and use informal and public transport for independence and
community integration;
(3)
Transportation service provided by different modalities, including
public and community transportation, taxi services,
transportation specific to prepaid transportation cards, mileage reimbursement,
volunteer transportation, and non-traditional transportation providers; and
(4) Prepaid transportation vouchers and cards.
(b) Payment for non-medical transportation shall be limited to $5,000 annually.
(c) If a family is transporting an individual,
payment shall only be made for transportation that is directly related to the child's disability or specific to a provider of transportation to
activities determined in the individual service agreement that are not
otherwise covered by the NH Medicaid state plan, including early periodic screening,
development, and training (EPSDT), and local education authority (LEA).
(d) Youth under the age of 16 shall not be
reimbursed for public transportation expenses.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.14 Personal Emergency Response Services
(PERS).
(a) “Personal emergency response services (PERS)” means smart technology devices that
enable individuals to summon help in an emergency including but not limited to:
(1) Wearable or portable devices that allow for safe mobility;
(2)
Response systems that are connected to the individual’s telephone and
programmed to signal a response center when activated;
(3) Staffed and monitored response systems that operate 24 hours a day, seven
days a week;
(4) Any device that informs of elopement; and
(5) Monthly expenses that are affiliated with maintenance contracts or agreements
to maintain the operations of the device or item.
(b)
PERS shall also include non-smart technology items, such as seatbelt
release covers, ID bracelets, and GPS devices.
(c)
Payment for PERS shall not exceed $2,000
annually for an individual.
(d)
The bureau shall authorize PERS in excess of the limitation in (c) above
upon written request which shall include documentation supporting the need and the correlation of the request to the
individual’s service agreement.
Source. #7891, eff 5-20-03; ss by #9122, eff 4-3-08;
ss by #10027, eff 11-17-11; ss by #13397, eff 6-18-22
He-M 524.15 Wellness Coaching.
(a) “Wellness
coaching” means planning, directing, coaching, and mentoring individuals with
disabilities in community based, inclusive exercise activities in
accordance with the recommendations of a licensed recreational therapist or a
certified personal trainer.
(b)
A wellness coach shall develop specific goals for the individual’s service
agreement, including activities that are carried over into the individual’s
home and community.
(c)
A wellness coach shall demonstrate exercise techniques
and form, observe individuals, and explain to them corrective measures
necessary to improve their skills.
(d)
A wellness coach shall collaborate with the individual, his or her
family and other caregivers, and with other health and wellness professionals as needed.
(e)
Wellness coaching provided through the home and community based
services waiver shall be in addition to, and not duplicative of, wellness
coaching which is available under the Medicaid state plan.
(f)
Coverage for wellness coaching shall be limited to 100 hours per year.
(g)
The bureau shall authorize payment for hours in excess of the limitation
in (f) above by written request, which shall include the recommendation of a licensed professional and documentation
supporting the need and the correlation of the request to the individual’s service
agreement.
Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff
6-18-22
He-M 524.16 Acute and Remote Setting Services.
(a)
Upon request, services in (d) and (e) below shall be provided in an acute
care hospital, only when the parent or guardian is not available and under the
following conditions:
(1) Identified
in an individual’s person-centered service agreement;
(2) Provided
to meet needs of the individual that are not met through the provision of
hospital services;
(3) Not
a substitute for services that the hospital is obligated to provide through its
conditions of participation or under federal or state law, or under another
applicable requirement; and
(4) Designed
to ensure smooth transitions between acute care settings and home and
community-based settings, and to preserve the individual’s functional
abilities.
(b) If services in (d) are provided
pursuant to (c)below, then those services shall be reviewed by the team at the
quarterly meeting to ensure this method of service delivery continues to meet
the individual’s needs.
(c)
Upon request, services in (d) below shall be provided remotely under the
following conditions:
(1) This
method of service delivery meets the assessed needs of the individual;
(2) The
individual, guardian, or representative chose this method of service delivery;
and
(3)
This method of service delivery is reviewed by the team at the quarterly
meeting to ensure that it continues to meet the individual’s needs.
(d) Services that may be provided in an acute care hospital pursuant to (a) above
or remote setting pursuant to (c) above shall include:
(1) In
home residential habilitation;
(2)
Service coordination; and
(3)
Consultative services.
(e)
Services that may be provided in an acute care
hospital pursuant to (a) above shall include:
(1) Assistive
technology;
(2) Environmental
and vehicle modifications;
(3) Respite
services; and
(4) PERS.
Source. #13397, eff 6-18-22
He-M 524.17 Non-Covered Services. The
following services shall not be funded under He-M 524:
(a) Educational services provided pursuant to
the Individuals with Disabilities Education Improvement Act (IDEIA) of 2004, 20
U.S.C. 1400 et seq.;
(b) Vocational or employment services provided
pursuant to IDEIA;
(c) Room and board;
(d) Custodial care programs;
(e) Services available to individuals birth
through 21 years of age under He-W 546, including early and periodic screening,
diagnosis, and treatment services;
(f) Services available
to individuals birth through 21 years of age under Title IV-E for foster care ;
and
(g) All other Medicaid state plan
services.
Source. #13397, eff 6-18-22 (formerly He-M 524.05)
He-M
524.18 Orienting Families to In-Home Supports. Before
services are delivered to an individual or a family, the area agency staff
shall meet with the individual, family, and representative and provide and
review a participant directed and managed services (PDMS) manual as an overview
of the supports available and available methods of service delivery, and inform
them of the following:
(a) The
services and supports available to the individual and family through He-M 524;
(b) Services
available outside of He-M 524, including other departmental services, community
resources, and institutional alternatives that might be pertinent to the individual’s
and family’s specific situation;
(c) The
benefits and applicable service limits of (a) and (b) above relative to the
family’s needs;
(d) The
features under He-M 524, including:
(1) That services are
directed and managed by the individual or representative;
(2) That a service
agreement is developed to include components listed in He-M 524.20 (a)(3);
(3) Area agency oversight of services provided;
(4) The completion of criminal
background checks on all prospective service providers;
(5) Responsibilities of providers, family members, and
the individual or representative in the provision of services and supports under each method of PDMS;
(6) The flexibility offered to identify possible
providers, including people known to the family such as extended family,
neighbors, or others in the local community; and
(7) The process of
having providers coming into the home environment;
(e) If
applicable, an explanation of alternative approaches to behavioral intervention,
including a description of the theory, practice, strengths, and expected
outcomes of the methods; and
(f) If
applicable, medication administration requirements under He-M 524.21(a)(7).
Source. #13397, eff 6-18-22 (formerly He-M 524.06)
He-M
524.19 Coordination of In-Home Supports.
(a) Once
an individual, family, and representative, choose to participate and the
individual is authorized pursuant to He-M 524.03 to receive services, a service
coordinator shall be chosen or approved by the individual or representative.
(b) Within
30 business days of being chosen by the individual or representative the
service coordinator shall hold the service planning meeting to create a service
agreement in accordance with He-M 524.20.
(c) The serv ice
coordinator shall:
(1) Maximize the
extent to which an individual, family, and representative participate in the service
planning process by:
a. Explaining the individual’s rights;
b. Explaining the service planning process;
c. Eliciting information regarding the
preferences, goals, and service needs of the individual and his or her family;
d. Reviewing
issues to be discussed during service planning meetings; and
e. Inviting
and assisting the family, representative, and individual, if age appropriate,
to determine the following elements in the service planning process:
1. The number and length of meetings;
2. The location and time of meetings;
3. The meeting participants; and
4. The topics to be discussed;
(2) Facilitate the service agreement meeting if the
individual or representative is unable to or chooses not
to select the facilitator of the meeting; and
(3) Document the
service agreement.
(d) If the individual or representative selects
a service coordinator who is not employed by the area agency or a subcontract
agency, the service coordinator and area agency shall enter into an agreement which
describes:
(1) The specific responsibilities
of the service coordinator;
(2) The reimbursement to
the service coordinator; and
(3) The oversight
activities to be provided by the area agency.
Source. #13397, eff 6-18-22 (formerly He-M 524.07)
He-M
524.20 In-Home Supports Service Agreement.
(a) The
service agreement describing services provided pursuant to He-M 524 shall:
(1) Be
developed in accordance with He-M 524.19(b), He-M 503.10, excluding He-M
503.10(c)-(e), and unless otherwise listed below;
(2) Be developed jointly by the
individual, family, representative, providers, service coordinator, and
consultants in accordance with the individual’s interests, preferences, and
needs and the family’s and individual’s or representative’s priorities;
(3) Include the
following:
a. A
list of specific activities to be carried out, including those regarding
safety;
b. The
specific schedule for the provision of services;
c. Name(s)
of the person(s) responsible for providing the services;
d. Specific
documentation requirements;
e. Specific
contingency plans for assuring provision of service when the usual providers
are not available;
f. Emergency
contact information; and
g. An
individualized budget which specifies:
1. Service components;
2. Duration and frequency of services required; and
3. Itemized cost of services;
(4) Be amended at any time by the individual, family,
representative, service providers, service coordinator, and
others involved in the care of the individual through joint discussion, written
revision, and with indication of consent as shown by the signature of the
individual or representative; and
(5) Be reviewed, and if necessary, amended, as required
under (4) above, but at least annually, with:
a. Formal
discussion of the individual’s progress in developing greater independence and
life skills;
b. Documentation
of the family’s, representative’s, and individual’s satisfaction with the
service provision; and
c. Provision
and review of information regarding personal rights and the complaint process.
(b) Within
5 business days of completion of the service agreement, the area agency shall
send the individual, guardian, or representative the following:
(1) A copy of the expanded service agreement signed by the
area agency executive director or designee;
(2) The name, address, and phone number of the service
coordinator or service provider(s) who may be contacted to respond to questions
or concerns; and
(3) A description of
the procedures for challenging the proposed expanded service agreement pursuant
to He-M 524.25 for those situations where the individual, guardian, or representative
disapproves of the expanded service agreement.
(c)
The individual, guardian, or representative shall have 10 business days
from the date of receipt of the expanded service agreement to respond in writing, indicating approval
or disapproval of the service agreement. Unless otherwise arranged
between the individual, guardian, or representative and the area agency,
failure to respond within the time allowed shall constitute approval of the
service agreement.
(d) The
signature page of the service agreement shall document the individual’s or
representative’s informed consent and
that the individual or representative has been fully informed of community and
institutional service alternatives and of the right to a hearing, as defined in
He-C 201.02 (i), to dispute any component of the service agreement.
(e) If
either the individual or representative, or area agency executive director, or
designee, disapproves of the service agreement or an amendment proposed
pursuant to (a)(4) above, the dispute shall be resolved:
(1) Through informal discussions among
the individual, family, representative, service coordinator, and area agency
executive director;
(2) By reconvening a
service planning meeting;
(3) By the
individual or representative filing a complaint pursuant to He-M 202; or
(4) By filing a formal appeal pursuant to
He-M 524.25.
(f) When the service agreement has been approved by the
individual, guardian, or representative and area agency director, the services
shall be implemented and monitored as follows:
(1) A person
responsible for implementing any part of an expanded service agreement, including
goals and support services, shall collect and record information about services
provided and summarize progress as required by the service agreement or, at a
minimum, monthly;
(2) On at least a
monthly basis, the service coordinator shall visit or have verbal or video call
contact with the individual or persons responsible for implementing an expanded
service agreement and document these contacts;
(3) The service
coordinator shall visit the individual and contact the guardian, if any, in
person or through a video call at least quarterly, or more frequently if so specified
in the individual’s expanded service agreement, to determine and document:
a. Whether
services match the interests and needs of the individual;
b. Individual
and guardian satisfaction with services;
c. Progress
on the goals in the expanded service agreement; and
d. The utilization of allocated funds.
(4) At least
2 of the service coordinator’s quarterly visits with the individual shall be
conducted in person in the home where the individual resides.
Source. #13397, eff 6-18-22 (formerly He-M 524.08)
He-M
524.21 Administrative Requirements.
(a) When
in-home supports are provided, the area agency shall, in collaboration with the
individual or representative and family and, if applicable, the subcontract
agency, specify the roles of the area agency, family, individual or representative,
and subcontract agency in service planning, service provision, and oversight
including:
(1) Implementation of
the service agreement;
(2) Specific
training and supervision requirements for service providers;
(3) Compensation
amounts and procedures for paying providers;
(4) Oversight of
the service provision, as required by the service agreement;
(5) Documentation of
compliance with He-M 524.21 through He-M 524.24;
(6) Employer
services provided by the area agency, subcontract agency, or other person or
entity to facilitate the delivery of in-home supports;
(7) Compliance with applicable laws and rules, including
delegation of medication administration and other nursing-related tasks by a nurse to unlicensed providers pursuant to Nur
404 or He-M 1201;
(8) The provision of service coordination; and
(9) Procedures for
review and revision of the service agreement as deemed necessary by any of the
parties.
(b) When
an individual or representative chooses in-home supports to be provided by an
entity other than the area agency or subcontract agency, the area agency shall:
(1) Discuss items specified under (a) above with the
individual, representative, and family to enable them to
make an informed decision regarding the roles and responsibilities of the
family and providers; and
(2) Establish a contract with the individual or
representative that specifies the parties responsible for the items under (a) above.
(c) The
individual or representative and the area agency shall develop an individualized
budget that includes:
(1) The
specific service components;
(2) The frequency and duration of the services
required;
(3) An itemized cost
of services; and
(4) The frequency at which budget reports pursuant to (e) below
will be provided by the area agency or subcontractor to the individual or
representative.
(d) The
individual or representative and the area agency shall develop a job
description for providers that outlines the expectations and responsibilities of
the provider.
(e) As
a part of the service provision, the area agency or subcontract agency shall
establish a budget reporting mechanism, detailing expenditures to date and the
amount remaining in the budget, to assist the individual or representative to
manage the individual’s budget.
Source.
#13397, eff 6-18-22 (formerly He-M 524.09)
He-M
524.22 Qualifications and Training.
(a) Providers
who are not a member of the individual’s family shall:
(1) With respect to qualifications and training, meet
the requirements specified in the service agreement and,
if applicable, medication administration requirements under He-M 524.21 (a)(7);
(2) Meet the
educational qualifications, or the equivalent combination of education and
experience, identified in the job description;
(3) Supply at
least one reference;
(4) Meet
certification and licensure requirements of the position, if any; and
(5) Be either:
a. A minimum of 18 years of age; or
b. With the agreement of the individual or
representative, and area agency, ages 15 through 17.
(b) All
providers, including providers who are family members, shall, prior to a final
hiring decision, be required by the employer to consent to:
(1) A New Hampshire criminal
records check no more than 30 days prior to hire;
(2) If the provider’s primary residence is out of state, a criminal
records check for their state of residence;
(3) If the provider has resided in New Hampshire
for less than one year, a criminal records check for their previous state of
residence; and
(4) A check of the state
registries of founded reports of abuse, neglect, and exploitation, as established
by RSA 161-F:49 and RSA 169-C:35.
(c) Except as allowed
in (d) and (e) below, an employer shall not hire a person:
(1) Who has a:
a. Felony
conviction; or
b. Any
misdemeanor conviction involving:
1. Physical or sexual assault;
2. Violence;
3. Exploitation;
4. Child pornography;
5. Threatening or reckless conduct;
6. Theft;
7. Driving under the influence of drugs or alcohol; or
8. Any other conduct that represents evidence of behavior that
could endanger the well-being of an individual; or
(2) Whose name is on either of the state registries of
founded abuse, neglect, and exploitation as established by RSA 161-F:49 and RSA
169-C:35.
(d) An employer may hire a person with a
criminal record listed in (c)(1)a. or b. above for a single offense that occurred
10 or more years ago in accordance with (e) and (f) below. In such
instances, the individual, his or her guardian if applicable, and the area
agency shall review the person’s history prior to approving the person’s
employment.
(e) Employment of a
person pursuant to (d) above shall only occur if such employment:
(1) Is approved by the individual, his or her guardian
if applicable, and the area agency;
(2) Does not
negatively impact the health or safety of the individual; and
(3) Does not
affect the quality of services to the individual.
(f) Upon hiring a person pursuant to (d) and (e)
above, the employer shall document and retain the following information in the
individual’s record:
(1) The date(s) of
the approvals in (e) above;
(2) The name of the individual for whom the person will
provide services;
(3) The name of the person hired;
(4) Description of
the person’s criminal offense;
(5) The type of
service the person is hired to provide;
(6) The employer’s name
and address;
(7) A full explanation of why the employer is hiring
the person despite the person’s criminal record;
(8) Signature of the individual, or of the legal guardian(s)
if applicable, indicating agreement with the employment and
date signed;
(9) Signature of
the staff person who obtained the individual’s or guardian’s signature and
date signed;
(10) Signature of
the area agency’s executive director or designee approving the employment; and
(11) The signature and phone number of the person being
hired.
(g) For
the purposes of (b) above, the area agency shall be the employer for parents
paid to provide in-home residential habilitation.
(h) The
employer shall provide information regarding the staff development elements
identified in He-M 506.05 to assist the individual or representative in making
informed decisions with respect to orientation and training of non-family staff
and providers.
(i) Subsequent
to (h) above, and consistent with the area agency or subcontract agency’s personnel
policies, the employer shall ensure that non-family staff and providers receive
the orientation and training selected by the individual or representative.
(j) The
service coordinator shall:
(1) For individuals aged
3 and over, comply with He-M 503.08(e) and (f); or
(2) For individuals under
age 3, comply with He-M 510.02 (ak) and He-M 510.11(j).
(k) When
an individual or representative chooses in-home supports to be provided by a
family member, the employer shall require the individual or representative to
submit documentation describing any orientation and training provided to the
family member.
(l) Providers of assistive technology, in accordance with
He-M 524.10, shall have specialized training relative to the specific item of
assistive technology.
(m) Providers of
consultative services, in accordance with He-M 524.07, shall meet one of the
following qualifications:
(1) Be a
psychiatrist, psychologist, or other provider that requires a license and hold
a valid license issued by the appropriate licensing board;
(2) For
other disability professionals who do not require professional licensure as
specified in (1) above, have specialized knowledge in the subject matter they
are providing consultative services for; or
(3) A master’s level clinical degree with
expertise and experience to provide supports to individuals with developmental
disabilities who are at risk for unsafe sexual behaviors or arson.
(n) Providers of
environmental or vehicle modifications in accordance with He-M 524.09
shall have any license,
certificate, or permit as required by state law or local ordinance for the
particular modification provider.
(o) Providers of non-medical transportation in accordance with He-M 524.13 shall:
(1) Have a current driver’s license;
(2) Consent to a New Hampshire driving record
check completed by the employer within 30 days or providing transportation; and
(3) Provide proof of automobile insurance.
Source. #13397, eff 6-18-22 (formerly He-M 524.10)
He-M
524.23 Quality
Assessment.
(a) The
service coordinator shall conduct visits and contacts as established in the
service agreement pursuant to 524.20 (f) and document the individual’s, family’s,
and representative’s satisfaction with:
(1) Staff and
providers such as their availability, compatibility, and adherence to the
provisions of the service agreement;
(2) Progress on
achieving the outcomes specified in the service agreement;
(3) Communication
among the individual, family, area agency, and providers;
(4) The individual’s health and safety supports as
identified in the service agreement; and
(5) The utilization of
allocated funds.
(b) The
bureau shall assess compliance with He-M 524 by reviewing documentation at the
area agency of the provision of in-home supports during redesignation of
area agencies pursuant to He-M 505.08.
Source. #13397, eff 6-18-22 (formerly He-M 524.11)
He-M
524.24 Documentation. For
each individual served, the provider, staff, or family member shall document
and maintain at the area agency a record containing the following:
(a) A
weekly schedule indicating the type and
duration of specific in-home supports provided;
(b) The
service agreement, in accordance He-M
524.20;
(c) The
individualized budget;
(d) Provider
or staff progress notes written at least monthly, or more frequently if so
specified in the service agreement;
(e) The
applicable contract as specified in He-M 524.21 (b)(2);
(f) Relevant evaluations including the health risk screening tool (HRST), supports
intensity scale for individuals over the age of 16, and a current individualized
education plan (IEP); and
(g) Any other documentation required by the area agency or individual or
representative and specified in the service agreement.
Source. #13397, eff 6-18-22 (formerly He-M 524.12)
He-M
524.25 Appeals.
(a) An
individual or representative may choose to pursue informal resolution
to resolve any disagreement with an area agency, or, within 30 business days of
the area agency decision, she or he may choose to file a formal appeal pursuant
to (e) below. Any determination, action, or inaction by an area
agency may be appealed by an individual or representative.
(b) The following actions
shall be subject to the notification requirements of (c) below:
(1) Adverse
eligibility actions under He-M 524.03;
(2) Area agency disapproval of service agreements or proposed
amendments to service agreements pursuant to He-M 524.20 (b); and
(3) Denial of services by
the bureau pursuant to He-M 524.26 (c).
(c) The bureau or an area agency shall provide written and verbal notice
to the applicant and representative of the actions specified in (b) above,
including:
(1) The specific rules that support, or the federal or
state law that requires, the action;
(2) Notice of the
individual’s right to appeal in accordance with He-C 200 within 30 days and the
process for filing an appeal, including the contact information to initiate the
appeal with the bureau administrator;
(3) Notice of the individual’s continued
right to services pending appeal, when applicable, pursuant to (g) below;
(4) Notice of
the right to have representation with an appeal by:
a. Legal counsel;
b. A relative;
c. A friend; or
d. Another spokesperson;
(5) Notice that neither the area agency nor the bureau
is responsible for the cost of representation;
(6) Notice of
organizations with their addresses and phone numbers that might be available
to provide legal assistance and advocacy, including the Disabilities Rights
Center and pro bono or reduced fee assistance; and
(7) Notice of individual’s right to request a second
formal risk assessment from a qualified evaluator.
(d) Appeals shall be submitted, in writing, to the bureau administrator in
care of the department’s office of client and legal services within 30 days
following the date of the notification of an area agency’s
decision. An exception shall be that appeals may be filed verbally
if the individual is unable to convey the appeal in writing.
(e) The
office of client and legal services
shall immediately forward the appeal to the department’s administrative appeals
unit which shall assign a presiding officer to conduct a hearing, as provided
in He-C 200. The burden shall be as provided by He-C 203.14.
(g) If
a hearing is requested, the following
actions shall occur:
(1) For current recipients, services and payments shall
be continued as a consequence of an appeal for a hearing until a decision has
been made; and
(2) If the bureau’s or area agency’s decision is upheld,
benefits shall cease 60 days from the date of the denial letter or 30 days from the hearing decision, whichever is later.
Source. #13397, eff 6-18-22 (formerly He-M 524.13)
He-M
524.26 Funding and Payment.
(a) Area
agencies shall submit to the bureau a proposed individualized budget for each
individual requesting services under He-M 524. The
proposed budget shall contain detailed line item information regarding all
services to be requested.
(b) The
bureau shall review the proposed budget and issue a response within 10 business
days from the date of request.
(c) For
each request an area agency makes for funding individual services under He-M 524,
the bureau shall make the final determination on the
cost effectiveness of requested services.
(d) Based on an individualized budget approved by the bureau and service
agreement approved by the individual or representative, the area agency
shall request a prior authorization from the bureau.
(e) Requests for prior authorization shall include the documentation in
(d) above and be submitted to:
Bureau
of Developmental Services
Hugh J. Gallen State Office
Park
105
Pleasant Street
Concord, NH 03301
(f) If information submitted pursuant to (e)
above, or similar information obtained at any other time by the bureau,
indicates that an individual might no longer meet the criteria for home and
community-based care specified in He-M 524.03 the bureau shall re-determine the
individual’s eligibility pursuant to He-M 524.03 above.
(g) Once an area agency obtains a prior authorization from the bureau, it
shall submit claims for in-home supports electronically to the Medicaid Management
Information System.
(h) Payment for in-home supports shall only be made if prior authorization
has been obtained from the bureau.
(i)
The bureau shall approve requests for prior authorization that meet the
criteria in (j)-(k) below.
(j) Payment for in-home supports shall not be available to any service
provider who:
(1) Is a person under
age 18, except as specified in He-M 524.22(b)(2); or
(2) Is the
spouse of an individual receiving services.
(k) Payment
for provision of in-home residential habilitation shall be available to the
parent of an individual receiving in-home supports when the
following apply:
(1) The individual has
at least one of the following factors:
a. The
individual’s level of dependency in performing activities of daily living,
including the need for assistance with toileting, eating, or mobility, exceeds
that of his or her developmentally disabled peers as determined by a nationally
recognized standardized functional assessment tool;
b. The
individual requires support for a complex medical condition, including airway
management, enteral feeding, catheterization, or other similar procedures; or
c. The
individual’s need for behavioral management exceeds that of his or her developmentally
disabled peers, as determined by a nationally recognized standardized behavioral
assessment tool, and the child’s destructive or injurious behavior represents a
risk for serious injury or death;
(2) The
parent has at least one of the following factors:
a. The
parent has exhausted all options for obtaining in-home support assistance due
to the lack of availability of qualified providers, as exemplified in (l)
below; or
b. The
child’s need for care has an imminent, negative effect on a parent’s ability to
maintain paid employment; and
(3) The
parent meets all applicable provider qualifications pursuant to He-M 524.22 and
all documentation requirements of He-M 524.24.
(l) Examples of lack of availability of qualified providers shall include the
following:
(1) A family lives
in a rural or remote area and cannot secure providers;
(2) The extensive medical or behavioral needs of the
child prevent the recruiting and maintaining of providers;
(3) A family whose
cultural background is different from the culture of the overall pool of
providers cannot secure providers who demonstrate cultural competence;
(4) A family’s work
schedule requires that providers be available during evening, overnight,
weekend, and holiday hours, thus making it difficult to retain providers;
(5) A family’s needs
are such that no provider agency can be identified or is available to provide
the required service; and
(6) Any other
circumstance or condition of a parent or child or of local provider agencies
that results in a family being unable to obtain in-home support assistance.
(m) The
area agency shall administer payments to parents for in home residential
habilitation and submit requests for parent payment
to BDS for prior authorization.
(n) Payments to
parents under (k) above shall apply solely to the provision of in home
residential habilitation services.
(o) When
a parent is paid to provide in-home residential habilitation, the number of
hours for which a parent will receive
payment shall be specified in the service agreement.
Source. #13397, eff 6-18-22 (formerly He-M 524.14)
He-M 524.27 Waivers.
(a) An
area agency, subcontract agency, individual, representative, or provider may request
a waiver of specific procedures outlined in He-M 524 using the form titled “NH
Bureau of Developmental Services Waiver Request” (July 2019). The
area agency shall submit the request in writing to the bureau administrator.
(b) A completed waiver
request form shall be signed by:
(1) The
individual or representative indicating agreement with the request; and
(2) The area
agency’s executive director or designee recommending approval of the waiver.
(c) A waiver request shall be submitted to:
Bureau
of Developmental Services
Hugh J. Gallen State Office
Park
105
Pleasant Street, Main Building
Concord, NH 03301
(d) No provision or procedure prescribed by statute shall be
waived.
(e) The request for
a waiver shall be granted by the commissioner or his or her designee within 30
days if the alternative proposed by the area agency, subcontract agency,
individual, representative, or provider meets the objective or intent of the
rule and it:
(1) Does not negatively impact the health or safety of
the individual(s); and
(2) Does not affect the quality of services to
individuals.
(f) The determination on the request for a waiver shall
be made within 30 days of the receipt of the request.
(g) Upon receipt
of approval of a waiver request, the grantee’s subsequent compliance with the
alternative provisions or procedures approved in the waiver shall be considered
compliance with the rule for which waiver was sought.
(h) Waivers shall be granted in writing for a specific duration not to
exceed 5 years except as in (i) below.
(i) Those
waivers which relate to issues relative to the health, safety, or welfare of
individuals that require periodic reassessment shall be
effective for a one-year period only.
(j) Any
waiver shall end with the closure of
the related program or service.
(k) An
area agency, subcontract agency,
individual, representative, or provider may request a renewal of a waiver from
the department. Such request shall be made at least 90 days prior to
the expiration of a current waiver.
Source. #13397, eff 6-18-22 (formerly He-M 524.15)
PART He-M 525 PARTICIPANT DIRECTED AND MANAGED SERVICES
Statutory Authority: New
Hampshire RSA 171-A:3; RSA 171-A:18, IV; RSA 137-K:3, IV
He-M 525.01 Purpose and Scope.
(a)
The purpose of these rules is to establish minimum standards for
participant directed and managed services for individuals who have a developmental
disability or acquired brain disorder.
(b)
Participant directed and managed services (PDMS) enable individuals who
have a developmental disability or acquired brain disorder to direct their services
and to experience, to the greatest extent possible, independence, community
inclusion, employment, and a fulfilling home life, while promoting personal
growth, responsibility, health, and safety.
(c)
These rules shall not apply to individuals who receive services under He-M
524, in-home supports.
(d) Nothing in these rules shall supersede the
provisions of He-M 503.08 regarding service guarantees for persons with
developmental disabilities.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M
525.02 Definitions.
(a)
“Area agency” means “area agency” as defined under RSA 171-A:2, I-b.
(b)
“Area agency director” means that person who is appointed as executive
director or acting executive director of an area agency by the area agency’s
board of directors.
(c)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(d)
“Bureau administrator” means the chief administrator of the bureau of
developmental services.
(e)
“Department” means the New Hampshire department of health and human
services.
(f)
“Developmental disability” means “developmental disability” as defined
in RSA 171-A:2,V, namely, “a disability:
(a) Which is attributable to intellectual
disability, cerebral palsy, epilepsy, autism or a specific learning disability
or any other condition of an individual found to be closely related to an intellectual
disability as it refers to general intellectual functioning or impairment in
adaptive behavior or requires treatment similar to that required for persons
with an intellectual disability; and
(b) Which originates before such individual attains
age 22, has continued or can be expected to continue indefinitely, and
constitutes a severe disability to such individual’s ability to function
normally in society.”
(g)
“Direct and manage” means to be actively involved in all aspects of the
service arrangement, including:
(1) Designing the services;
(2) Selecting the service providers;
(3) Deciding how the authorized funding is to be
spent based on the needs identified in the individual’s service agreement; and
(4) Performing ongoing oversight of the services
provided.
(h)
“Employer” means an area agency or subcontract agency or person that
handles legally defined and other employer-related functions such as, but not
limited to:
(1) Paying employer taxes;
(2) Withholding employee taxes;
(3) Performing other payroll functions, including
issuing paychecks;
(4) Providing workers’ benefits; and
(5) Obtaining workers’ compensation and liability
insurance.
(i)
“Family” means a group of 2 or more persons related by ancestry, marriage,
or other legal arrangement that has at least one member who has a developmental
disability or acquired brain disorder.
(j)
“Guardian” means a person appointed pursuant to RSA 547-B, RSA 463, or
RSA 464-A or the parent of a child under the age of 18 whose parental rights
have not been terminated or limited by law.
(k)
“Home provider” means a person who is under contract with the area
agency, a subcontract agency, or another entity and who is responsible for
providing services to an individual in the provider’s home.
(l)
“Individual” means a person who is eligible for developmental services
or services for acquired brain disorder pursuant to He-M 503 or He-M 522.
(m)
“Informed decision” means “informed decision” as defined in RSA 171-A:2,
XI.
(n)
“Nursing-related tasks” means those nursing services that are delegated
to unlicensed personnel and:
(1) That are routine in nature;
(2) That do not require nursing judgment;
(3) That pose little risk to the individual if
done inappropriately or incorrectly; and
(4) Whose outcomes are stable and predictable.
(o)
“Participant directed and managed services (PDMS)” means services
provided pursuant to He-M 525 whereby the individual or representative, if
applicable, directs and manages the services as defined in (g) above. Services include assistance and resources to
individuals in order to maintain or improve their skills and experiences in
living, working, socializing, and recreating.
(p)
“Provider” means a person receiving any form of remuneration for the
provision of services to an individual.
(q)
“Representative” means:
(1) The parent or guardian of an individual under
the age of 18;
(2) The legal guardian of an individual 18 or
over; or
(3) A person who has power of attorney for the
individual.
(r)
“Respite” means the provision of short-term care, in accordance with
He-M 513, for an individual in or out of the individual’s home for the
temporary relief and support of the family with whom the individual lives.
(s)
“Service coordinator” means a person who meets the criteria in He-M
503.08(e) – (f) and is chosen or approved by an individual and his or her
guardian or representative and designated to organize, facilitate, and document
service planning and to negotiate and monitor the provision of the individual’s
services and who is:
(1) An area agency service coordinator, family
support coordinator, or any other area agency or subcontract agency employee;
(2) A member of the individual’s family;
(3) A friend of the individual; or
(4) Any other person chosen by the individual.
(t)
“Sheltered workshop” means a program run by an area agency or a
subcontract agency, person, or entity that provides a segregated work environment.
(u)
“Staff” means a person employed by an area agency, subcontract agency,
or other employer.
(v)
“Staffed home” means a residence owned or leased by an area agency or
subcontract agency exclusive of any independent living arrangement where
supports are provided to the individual.
(w)
“Subcontract agency” means an entity that is under contract with any
area agency to provide services to individuals who have a developmental disability
or acquired brain disorder.
(x)
“Team” means that group that participates in service planning and review
meetings and includes the individual and his or her service coordinator and
representative and others invited by the individual.
Source. #9391, eff 2-21-09; ss by #9890-A, eff 3-22-11;
ss by #12859, eff 8-28-19
He-M 525.03 Eligibility.
(a)
PDMS shall be open to any individual who:
(1) Is eligible and has funding for services
pursuant to He-M 503 or He-M 522; and
(2) Wishes to direct, or whose representative
wishes to direct, his or her services.
(b)
PDMS shall not be used in congregate service arrangements or programs
where individuals, families, or guardians do not direct and manage the services
and approved funding pursuant to He-M 525.02 (g) and there is a per diem payment
made to the provider rather than a budget that is available to the individual,
family, or guardian to manage.
(c)
Individuals who receive services under He-M 524 shall not be eligible
for services under this part.
(d)
A person shall not be eligible to receive payment for providing services
under He-M 525 if he or she is the spouse of the individual.
(e) PDMS shall not be available for an individual
with the following:
(1) Incident(s) of behaviors that pose a risk to
community safety with or without police or court involvement, or a history of
civil commitment under RSA 171-B;
(2) A formal risk assessment conducted within the
past year by a N.H. licensed psychologist or psychiatrist that finds the
individual poses a moderate or high risk to community safety and includes
recommendations on the level of security, services, and treatment necessary for
the individual; and
(3) Concurrence from the area agency’s human
rights committee, established pursuant to RSA 171-A:17, I, that services under
He-M 525 would not provide the degree of security, services, or treatment
needed by the individual.
(f)
Upon a positive finding pursuant to (e)(2) above, the individual may
obtain a second opinion from a New Hampshire licensed psychologist or
psychiatrist.
(g)
The human rights committee shall consider the findings of the assessment
conducted in (f) above.
(h)
If a human rights committee convenes pursuant to (e)(3) or (g) above,
the committee shall meet, if requested, with the individual and the individual’s
representative.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.04 Non-Covered
Services. The following services
shall not be fundable under this part:
(a) Custodial care programs provided only to maintain
the individual’s basic welfare;
(b) Educational services or education programs
for individuals under 21 years of age for which school districts are responsible;
(c) Sheltered workshops; and
(d) Services not related to supports required because
of an individual’s developmental disability or acquired brain disorder.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.05 Service Principles.
(a)
PDMS shall promote the individual’s and his or her representative’s
involvement, choice, and control in all levels of planning, provision, and monitoring
of services.
(b)
Individuals who are involved in PDMS may identify others of their choice
to assist them in directing their services.
(c)
PDMS shall:
(1) Be tailored to the individual’s competencies,
interests, preferences, and needs;
(2) Promote the health, safety, and emotional
well-being of the individual;
(3) Be provided in a manner which protects the
individual’s rights as described in He-M 202 and He-M 310; and
(4) Provide the degree of support an individual
needs to direct services, increase his or her level of independence, and
advocate for himself or herself.
(d)
PDMS that support families who are caring for their family members
shall:
(1) Respect each family’s values, beliefs, and
traditions; and
(2) Recognize and draw on each family’s strengths
and competencies.
(e)
For an individual who is 21 years of age or older, PDMS shall include
supports identified in the service agreement, such as:
(1) Personal care, employment supports, adult basic
education, and avocational and leisure activities;
(2) Adaptations through environmental and vehicle
modifications and assistive technology;
(3) Services that assist the individual to
acquire and maintain life skills in such areas as personal safety, meal
preparation, and budgeting;
(4) Services that, based on the individual’s
preferences, broaden his or her life experiences through social, artistic, and
spiritual expression;
(5) Respite and family support services that meet
the needs of individuals living with their families;
(6) Provider training including, at a minimum:
a. Individual rights; and
b. Universal precautions and other nursing-related
tasks;
(7) Consultations and assessments; and
(8) Services needed, but not currently available.
(f)
For an individual who is under the age of 21, PDMS shall include supports
identified in the service agreement for the individual and his or her family,
such as:
(1) Respite;
(2) Environmental and vehicle modifications, and
assistive technology;
(3) Provider training including, at a minimum:
a. Individual rights; and
b. Universal precautions and other
nursing-related tasks;
(4) Consultations and assessments; and
(5) The following, to the extent that they are
not the responsibility of the school district to provide:
a. Transition planning;
b. After school supports; and
c. Acquisition and maintenance of life skills,
such as:
1. Preparing meals;
2. Budgeting;
3. Obtaining and maintaining employment;
4. Socializing; and
5. Maintaining personal safety.
(g)
The area agency or subcontract agency shall discuss options for service
provision with the individual and representative.
(h)
The individual or representative shall select the provider and staff to
deliver PDMS based on the discussion of options required in (g) above.
(i)
When the individual or representative opts for services that are to be
provided by a person or an entity other than the area agency or a subcontract
agency:
(1) The area agency shall hire the person or contract
with the person or entity, consistent with the area agency’s or subcontract
agency’s personnel policies; or
(2) The individual or representative may choose
to hire or contract with the person or entity.
(j)
If the individual or representative chooses to hire or contract with the
person or entity:
(1) The area agency shall:
a. Approve the identified person or entity;
b. Discuss with the individual and representative
each party’s responsibilities regarding service planning, provision, and
oversight; and
c. Establish a contract with the individual or
representative regarding service planning, provision, and oversight; and
(2) The individual or representative shall give
to the area agency a copy of any contract established with a contractor
pursuant to (i)(2) above.
(k)
In those situations where the area agency does not approve the individual’s
or representative’s selection of a person or entity, the area agency shall:
(1) Provide, in writing, the reasons why the area
agency will not hire, contract with, or approve the person or entity;
(2) Advise the individual or representative in
writing and verbally of his or her appeal rights under He-M 525.11; and
(3) Assist the individual or representative in
selecting another person or entity to provide the services, as needed.
Source. #9391, eff 2-21-09; ss by #9890-A, eff 3-22-11;
ss by #12859, eff 8-28-19
He-M 525.06 Administrative, Service, and Personnel
Requirements.
(a)
Service planning shall be conducted in accordance with He-M 503.09.
(b)
The service coordinator shall assist the individual and representative
and other persons chosen by the individual to develop a written service agreement
in accordance with the principles outlined in He-M 525.05, signed by the individual
or representative and the area agency director or designee, that includes the following:
(1) A brief description of the individual’s
strengths, needs, and interests, as applicable;
(2) The individual’s clinical and support needs
as identified through current evaluations and assessment;
(3) The specific services to be furnished and the
goal associated with each service;
(4) The amount, frequency, duration, and desired
outcome of each service;
(5) Timelines for initiation of services;
(6) The provider to furnish the services;
(7) The individual’s need for guardianship, if any;
(8) Service documentation requirements for
tracking outcomes and service provision, including the type of documentation;
(9) Identification of the person or entity
responsible for monitoring the plan;
(10) The frequency of service coordinator visits
with the individual and contact with the representative pursuant to He-M 525.08
(a) and (b);
(11) An individualized budget pursuant to (g)
below; and
(12) If medication is administered, provision for
compliance with (k)(5) below.
(d)
Requirements for documentation of service provision shall be specified
in the service agreement and include, at minimum:
(1) The
dates services are provided; and
(2) Reports on progress toward achieving desired
outcomes.
(e)
Service agreements shall be renewed at least annually and include a
review of guardianship.
(f)
Amendments to the service agreement may be made at any time. Amendments shall be documented by the service
coordinator with the approval of the individual or representative and the area
agency director or designee.
(g)
The individual or representative and the area agency shall develop an
individualized budget that includes:
(1) The specific service components;
(2) The frequency and duration of the services
required;
(3) An itemized cost of services; and
(4) The frequency at which budget reports will be
provided by the area agency or subcontractor to the individual or
representative pursuant to (h) below.
(h)
In providing services, the area agency or subcontract agency shall establish
a budget reporting mechanism, detailing expenditures to date and the amount
remaining in the budget, to assist the individual -and representative to manage
his or her budget.
(i)
When PDMS are to be provided by a subcontract agency of the area agency,
one of the following shall apply:
(1) The individual or representative shall establish
an agreement with the subcontract agency; or
(2) The area agency shall establish a contract with
the subcontract agency for service provision and oversight.
(j)
Agencies providing PDMS shall have policies regarding:
(1) Administration of medication, pursuant to
(k)(5) below; and
(2) Individual rights in accordance with He-M 202
and He-M 310.
(k)
For individuals who are 21 years of age or older, the following shall
apply:
(1) Unless otherwise requested by the individual
or representative the area agency or a subcontract agency shall be the
employer;
(2) When the individual or representative
requests to be the employer or designates an entity to perform that function
that is not a subcontractor of an area agency, the area agency shall identify
and review with the individual and representative the responsibilities
referenced in (3) below;
(3) Prior to hiring or contracting with a staff
or provider, the individual, representative, or area agency or subcontract
agency that intends to contract with a provider, shall:
a. Submit the name of the person and all other
persons residing in the home of a non-family provider for review against the
registry of founded reports of abuse, neglect, and exploitation to ensure that
the person is not on the registry pursuant to RSA 169-C:35 or RSA 161-F:49;
b. Complete a criminal records check in New
Hampshire, no more than 30 days prior to contracting with the person to ensure
that he or she and all other persons residing in the home of a non-family provider
have no history of fraud, felony, or misdemeanor conviction;
c. Complete a criminal records check for the
person’s state of residence if it is not New Hampshire to ensure that the person
and all other persons residing in the home of a non-family provider have no
history of fraud, felony, or misdemeanor conviction;
d. Complete a criminal records check for the
person’s previous state of residence if he or she has resided in New Hampshire
for less than one year to ensure that the person and all other persons residing
in the home of a non-family provider have no history of fraud, felony, or
misdemeanor conviction;
e. Provide information obtained pursuant to (3)
a. above to the area agency;
f. Obtain at a minimum one reference on each
prospective staff or non-family provider;
g.
Provide proof of insurance coverage, including general liability and workers’
compensation, to the area agency; and
h. Comply, as applicable, with all employer-employee
legal requirements such as wage reporting and tax withholding;
(4) An individual, representative, area agency,
or subcontract agency may hire a person with a criminal record listed in (3) b.-d. above for a single offense that occurred 10
or more years ago in accordance with (5) and (6) below. In such instances, the individual, his or her
guardian, if applicable, the area agency, and the subcontract agency, if
applicable, shall review the person’s history prior to approving the person’s
employment;
(5) Unless a waiver is granted pursuant to (6)
below, an individual, representative, area agency, or subcontract agency shall
not hire a person with a criminal record, other than as specified in (4) above;
(6) The department may grant a waiver of (5) above
if, after reviewing the underlying circumstances, it determines that the person
does not pose a threat to the health, safety, or well-being of individuals;
(7) Employment of a person pursuant to (4) above
shall only occur if such employment:
a. Is approved by the individual, his or her
guardian if applicable, the area agency, and the subcontract agency if
applicable;
b. Does not negatively impact the health or
safety of the individual(s); and
c. Does not affect the quality of services to individuals;
(8) Upon the hiring of a person pursuant to (4)
above, the area agency shall document and retain the following information in
the individual’s record:
a. The dates of the approval in (4) above;
b. The name of the person hired;
c. The description of the person’s criminal
offense;
d. The type of service the person is hired to
provide;
e. The subcontract agency’s name and address, if
applicable;
f. A full explanation as to why the individual,
representative, or agency is hiring the person despite the person’s criminal
record;
g. The signature of the individual, guardian, or
representative indicating agreement with the employment and the date signed;
h. The signature of the area agency representative
approving the employment; and
i. The signature and phone number of the person
being hired;
(9)
All personnel shall sign a statement annually, which shall be maintained
in the personnel file, stating that since the time of hire they:
a. Have not been convicted of a felony or
misdemeanor in this or any other state; and
b. Have not had a finding by the department or
any administrative agency in this or any other state for assault, fraud, abuse,
neglect, or exploitation of any person;
(10) Medication administration shall:
a. Comply with He-M 1201 or Nur 404 except in
situations where the individuals are living with their families and receiving
respite arranged by the family; or
b.
When performed by family members paid under He-M 525, include discussion
between the area agency or subcontract agency and the family about any concerns
the family might have regarding medication administration;
(11) Provision of nursing-related tasks shall:
a.
Comply with Nur 404 except in situations where individuals are living with
their families and receiving respite arranged by the family; or
b.
When performed by family members paid under He-M 525, include discussion
between the area agency or subcontract agency and the family about concerns the
family might have regarding the provision of nursing-related tasks;
(12) Staff and providers who are not family
members shall:
a.
Meet the educational qualifications, or the equivalent combination of
education and experience, identified in the job description;
b.
Meet the certification and licensing requirements of the position, if
any; and
c.
Be 18 years of age or older;
(13) The employer, when not the individual or
representative, shall provide information to the individual and representative
regarding the staff development elements identified in He-M 506.05 to assist
him or her in making informed decisions with respect to orientation and
training of staff and providers; and
(14) Subsequent to (13) above and consistent with
the area agency’s or subcontract agency’s personnel policies, the employer
shall ensure that the staff and providers receive the orientation and training
selected by the individual or representative.
(l)
In addition to complying with (k) above, when an individual is 21 years
of age or older and lives in a staffed home:
(1) The home shall comply with applicable local
and state health, zoning, building, and fire codes;
(2) The physical layout and environment of the
home shall meet the health and safety needs of the individual;
(3) A signed statement from the local fire
official shall be obtained before the individual moves into the home:
a.
Verifying that the home complies with all state and local fire codes;
and
b.
Specifying the number of beds that can safely be occupied by individuals
living in the home; and
(4) Quarterly fire drills in the home shall be
conducted and documented such that:
a.
One drill per year shall be conducted during sleep hours; and
b.
The first drill shall be conducted no more than 5 days after the
individual has moved into the home.
(m)
In addition to complying with (k) above, when an individual is 21 years
of age or older and lives with a home provider who is not a family member, the
home shall have:
(1) An integrated fire alarm system with a functioning
smoke detector in each bedroom and on each level of the home including the
basement and attic, if the attic is used as living or storage space;
(2) A functioning septic or other sewage disposal
system;
(3) A source of potable water for drinking and
food preparation, such that, if the water for drinking and food preparation is
not from a public water supply:
a. At the time of the initial certification
there shall be well water test results less than 2 years old that indicate the
water is potable; or
b. There shall be documentation that bottled
water is used; and
(4) Two means of egress.
(n)
If the home in which supports are provided is not owned by a family
member, a fire safety assessment shall be conducted by staff in a staffed home
or a home provider, when not a family member, to address the individual’s following
risk factors:
(1) Response to alarm;
(2) Response to instructions;
(3) Vision and hearing difficulties;
(4) Impaired judgment;
(5) Mobility problems; and
(6) Resistance to evacuation.
(o)
Based on the findings of the fire safety assessment, the individual and
other members of his or her team shall develop a fire safety plan that
addresses fire drill frequencies, procedures to achieve evacuation within 3
minutes, and other fire safety related strategies determined by the team to be
applicable.
(p)
When an individual’s service agreement specifies unsupervised time and
the provider is not a family member, the staff in a staffed home or the home provider
shall conduct a personal safety assessment that identifies the individual’s
ability to demonstrate the following safety skills:
(1) Responding to a fire, including exiting
safely and seeking assistance;
(2) Caring for personal health, including understanding
health issues, taking medication, seeking assistance for health needs and
applying basic first aid;
(3) Seeking safety if victimized or sexually
exploited;
(4) Negotiating one’s community, including
finding one’s way, riding in vehicles safely, handling money safely, and
interacting with strangers appropriately;
(5) Responding appropriately in severe weather
and other natural disasters, including storms and extreme temperature; and
(6) Maintaining a safe home, including:
a. Operating heating, cooking, and other appliances;
and
b. Responding to common household problems such
as a blocked toilet, power failure or gas odors.
(q)
Based on the findings of the personal safety assessment, the individual
and other members of his or her team shall develop a personal safety plan that:
(1) Identifies any supports necessary for an
individual to respond to each of the contingencies listed in (p) above;
(2) Indicates who will provide the needed
supports;
(3) Describes how the supports will be activated
in an emergency;
(4) Indicates approval of the individual or legal
guardian, provider, residential coordinator, and service coordinator;
(5) Is reviewed by the provider or staff at the
time of the individual’s service agreement; and
(6) Is revised whenever there is a change in the
individual’s residence or ability to respond to the contingencies listed in the
plan.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.07 Certification.
(a)
PDMS provided in the home to individuals who are 21 years or older shall
be certified by the bureau, except for respite care or in those situations
where the individual is living independently.
(b)
To facilitate the certification process, the area agency shall:
(1) Review the service arrangement and
documentation to confirm that all applicable requirements identified in He-M
525.06 are being met; and
(2) Forward to the bureau, 30 days prior to the
initiation of services, the individual’s proposed service agreement and proposed
individualized budget and the area agency’s recommendation for certification.
(c)
Within 14 days of receiving the area agency recommendation, the bureau
shall issue a certification if the requirements in He-M 525.06 are being met.
(d)
All certifications granted by the bureau under (c) above shall be
effective for no more than 24 months.
(e)
To renew a PDMS certification, the area agency shall:
(1) Review the service arrangement and documentation
to confirm that all applicable requirements identified in He-M 525.06 are being
met; and
(2) Forward to the bureau the individualized budget,
the service agreement, and the area agency’s recommendation for
re-certification 30 days prior to the expiration of the current services.
(f)
Within 14 days of receiving the area agency recommendation, the bureau
shall renew a certification if the requirements in He-M 525.06 and He-M 525.12
(b) are being met.
(g)
Upon request by the area agency, the bureau shall issue a 60-day
emergency certification to enable an individual to relocate to a staffed or
provider home if the area agency executive director, or his or her designee,
submits to the bureau a signed statement documenting that the individual’s
safety has been addressed.
(h)
Within 5 business days of an individual’s relocation pursuant to (g)
above, a service coordinator and licensed nurse shall visit the individual in
the home to determine if the transition has resulted in adverse changes in the
health or behavioral status of the individual.
(i)
A service coordinator shall document the visit described in (h) above in
the individual’s record.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.08 Quality Review.
(a)
When an individual receives services in a staffed home or with a home provider,
the service coordinator shall contact the representative and visit with the
individual at least twice a year in the home where the individual resides, or
more frequently if specified in the service agreement.
(b)
When an individual lives with his or her family or in his or her own
home, the individual or representative and service coordinator shall establish
within the service agreement the minimum number of:
(1) Service coordinator visits per year with the
individual in the home; and
(2) Contacts with the representative per year.
(c)
Based on the frequency identified in the service agreement, the service
coordinator shall visit with the individual and contact the representative and
document their satisfaction with:
(1) Staff or providers such as their availability,
compatibility, and adherence to the provisions of the service agreement;
(2) Progress on achieving the outcomes specified
in the service agreement;
(3) Communication among the individual, the
representative, the area agency, and the providers;
(4) The individual’s health and safety supports
as identified in the service agreement; and
(5) The utilization of allocated funds.
(d)
The bureau shall conduct yearly reviews of PDMS to ensure compliance
with this part by reviewing documentation at the area agency of, at minimum,
10% of participant directed and managed service arrangements.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.09 Denial and Revocation of Certification.
(a)
In the event of the denial or revocation of certification of PDMS, the
individual’s service coordinator shall assist him or her to continue receiving
alternative services that meet his or her needs.
(b)
The bureau shall deny an application for certification or revoke certification
of PDMS, following written notice pursuant to (d) below and opportunity for a
hearing pursuant to He-C 200, due to:
(1) Failure of a staff, provider, subcontract
agency, or area agency to comply with this part or any other applicable rule
adopted by the department;
(2) Hiring of persons below the age of 18 as
staff or non-family providers;
(3) Knowing submission of materially false or
misleading information to the department or failure to provide information
requested by the department and required pursuant to He-M 500;
(4) The staff, provider, subcontract agency, or
area agency preventing or interfering with any review or investigation by the
department;
(5) The staff, provider, subcontract agency, or area
agency failing to provide required documents to the department;
(6) Any abuse, neglect, or exploitation by a
provider, staff, or person living in a non-family provider’s home, as reported
on the state registry in accordance with RSA 161-F: 49, I (a), if such finding
has not been overturned on appeal, been annulled, or received a waiver pursuant
to He-M 525.13;
(7) Failure by the employer to perform criminal
background checks on all persons paid to provide services under He-M 525 who
begin to provide such services on or after the effective date of He-M 525;
(8) Except as allowed in He-M 525.06(k)(4), any
staff, provider, or person living in a non-family provider’s home has been
found guilty of fraud, a felony, or a misdemeanor against a person in this or
any other state by a court of law, unless a waiver has been obtained pursuant
to He-M 525.13; or
(9) Evidence that any provider or staff, working
directly with individuals, has an illness or behavior that, as evidenced by the
documentation obtained or the observations made by the department, would
endanger the well-being of the individuals or impair the ability of the provider
to comply with department rules, except in cases where such personnel have been
reassigned and the well-being of all individuals and the provider’s ability to comply
with these rules are no longer at risk.
(c)
If the department determines that services meet any of the criteria for
denial or revocation listed in (b) above, the department shall deny or revoke
the certification of the PDMS.
(d)
Certification shall be denied or revoked upon the written notice by the
department to the provider, subcontract agency, or area agency stating the
specific rule(s) with which the service does not comply.
(e)
Any certificate holder aggrieved by the denial or revocation of the
certificate may request an adjudicative proceeding in accordance with He-M
525.11. The denial or revocation shall
not become final until the period for requesting an adjudicative proceeding has
expired or, if the certificate holder requests an adjudicative proceeding,
until such time as the administrative appeals unit issues a decision upholding
the department’s action.
(f)
Pending compliance with all requirements for certification specified in
the written notice made pursuant to (d) above, a provider, subcontract agency,
or area agency shall not provide additional PDMS if a notice of revocation has
been issued concerning a violation that presents potential danger to the health
or safety of the individuals being served.
Source. #9391, eff 2-21-09; ss by #9890-A, eff 3-22-11; ss by #12859, eff 8-28-19
He-M 525.10 Immediate Suspension of Certification.
(a)
Notwithstanding the provision of He-M 525.09 (e), in the event that a
violation poses an immediate and serious threat to the health or safety of the
individuals, the bureau administrator shall, in accordance with RSA 541-A:30,
III, suspend a service’s certification immediately upon issuance of written
notice specifying the reasons for the action.
(b)
The bureau administrator or his or her designee shall schedule and hold
a hearing within 10 working days of the suspension for the purpose of determining
whether to revoke or reinstate the certification. The hearing shall provide opportunity for the
provider, subcontract agency, or area agency whose certification has been suspended
to demonstrate that it has been, or is, in compliance with the specified
requirements.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.11 Appeals.
(a)
An individual or guardian may choose to pursue informal resolution to
resolve any disagreement with an area agency, or, within 30 business days of
the area agency decision, she or he may choose to file a formal appeal pursuant
to (e) below. Any determination, action,
or inaction by an area agency may be appealed by an individual or guardian.
(b)
An applicant for certification, provider, subcontract agency, or area
agency may request a hearing regarding a proposed revocation or denial of
certification, except as provided in He-M 525.10 above.
(c) The following actions shall be subject to the
notification requirements of (d) below:
(1) Adverse
eligibility actions under He-M 525.03;
(2) Area
agency determinations regarding an individual’s or guardian’s selection of a
provider under He-M 525.05 (h) or removal of a provider under He-M 525.05 (k);
(3) Area
agency determinations regarding provider certification under He-M 525.09;
(4) Area
agency determinations regarding the removal of a service coordinator selected
by an individual or guardian under He-M 503.08(f) (2) and (3); and
(5) A
determination to terminate services under He-M 503.15 (f).
(d)
An area agency shall provide written and verbal notice to the applicant
and guardian of the actions specified in (c) above, including:
(1) The
specific rules that support, or the federal or state law that requires, the
action;
(2) Notice of the individual’s right
to appeal in accordance with He-C 200 within 30 business days and the process for
filing an appeal, including the contact information to initiate the appeal with
the bureau administrator;
(3) Notice of the individual’s
continued right to services pending appeal, when applicable, pursuant to (f)
below;
(4) Notice of the right to have representation
with an appeal by:
a. Legal counsel;
b. A relative;
c. A friend; or
d. Another spokesperson;
(5) Notice that neither the area agency nor the bureau
is responsible for the cost of representation;
(6) Notice of organizations with their addresses and phone numbers that
might be available to provide legal assistance and advocacy, including the
Disabilities Rights Center and pro bono or reduced fee assistance; and
(7) Notice of individual’s right
to request a second formal risk assessment from a qualified evaluator.
(e)
Appeals shall be submitted, in writing, to the bureau administrator in
care of the department’s office of client and legal services within 30 business
days following the date of the notification of an area agency’s decision or the
bureau’s denial or revocation of certification.
An exception shall be that appeals may be filed verbally if the individual
is unable to convey the appeal in writing.
(f)
The bureau administrator shall immediately forward the appeal to the
department’s administrative appeals unit which shall assign a presiding officer
to conduct a hearing or independent review, as provided in He-C 200. The burden shall be as provided by He-C
203.14.
(g)
If a hearing is requested, the following actions shall occur:
(1) For current recipients, services and payments
shall be continued as a consequence of an appeal for a hearing until a decision
has been made; and
(2) If the bureau’s decision is upheld, benefits
shall cease 60 days from the date of the denial letter or 30 days from the hearing
decision, whichever is later.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.12 Funding and Payment.
(a)
Area agencies shall submit to the bureau a proposed individualized
budget for each individual requesting initial provision of services under He-M
525, which contains detailed line item information regarding all services to be
provided.
(b)
The bureau shall review the proposed budget and issue a response within 10
business days from the date of request.
(c)
For each request an area agency makes for funding individual services
under He-M 525, the bureau shall make the final determination on the cost
effectiveness of the budget and proposed services.
(d)
Based on an approved individualized budget, service agreement and, if
applicable, certification issued pursuant to He-M 525.07 (c), the area agency
shall request a prior authorization from the bureau.
(e)
Requests for prior authorization shall be made in writing to:
Bureau of
Developmental Services
Hugh J. Gallen
State Office Park
105 Pleasant
Street
Concord, NH 03301
(f)
Once an area agency obtains a prior authorization from the bureau it
shall submit claims for Medicaid waiver PDMS to:
Conduent
2 Pillsbury
Street, Suite 200
Concord, NH 03301
(g)
Payment for medicaid waiver PDMS shall only be made if prior
authorization has been obtained from the bureau.
(h)
For those individuals whose net income exceeds the nursing facility cap
as established in He-W 658.05, area agencies shall subtract the cost of care
from the medicaid billings for the individuals unless they qualify for medicaid
for employed adults with disabilities (MEAD) pursuant to He-W 641.03.
(i)
In those situations where cost of care is subtracted from the medicaid
billings, the area agency shall recover the cost from individuals.
(j)
Payment for PDMS shall not be available to any service provider who:
(1) Is the parent of the individual under age 18;
(2) Is a person under age 18 if the individual is
21 years or older; or
(3) Is the spouse of an individual receiving
services.
Source. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11; ss by #12859, eff 8-28-19
He-M 525.13 Waivers.
(a) An area agency, subcontract agency,
individual, representative, or provider may request a waiver of specific
procedures outlined in He-M 525 by completing and submitting the department’s
form entitled “NH Bureau of Developmental Services Waiver Request” (July 2019).
The area agency shall submit the request in writing to the bureau
administrator.
(b) If the waiver request is of He-M 525.09 (b)
(8) or (9), the entity requesting a waiver shall include a copy of the relevant
criminal record check.
(c)
A completed waiver
request form shall be signed by:
(1) The individual, guardian, or representative
indicating agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(d)
A waiver request shall be submitted to:
Bureau of
Developmental Services
Hugh J. Gallen
State Office Park
105 Pleasant Street, Main Building
Concord, NH 03301
(e)
All information entered on the forms described in (a) above shall be
typewritten or otherwise legibly written.
(f)
No provision or procedure prescribed by statute shall be waived.
(g)
The request for a waiver shall be granted by the commissioner or his or
her designee within 30 days if the alternative proposed by the requesting
entity meets the objective or intent of the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not affect the quality of services to
individuals.
(h)
Upon receipt of approval of a waiver request, the requesting entity’s
subsequent compliance with the alternative
provisions or procedures approved in the waiver shall be considered compliance
with the rule for which waiver was sought.
(i)
Waivers shall be granted in writing for the minimum period necessary to
accomplish the waiver request’s purpose with the specific duration not to
exceed 5 years except as in (j)-(k) below.
(j)
Those waivers which relate to the following shall be effective for the
current certification period only:
(1) Fire safety; or
(2) Other issues relative to the health, safety
or welfare of individuals that require periodic reassessment.
(k)
Any waiver shall end with the closure of the related program or service.
(l)
An area agency, subcontract agency, individual, representative, or
provider may request a renewal of a waiver from the bureau. Such request shall be made at least 90 days prior
to the expiration of a current waiver.
(m)
A request for renewal of a waiver shall be approved in accordance with
the criteria specified in (g) above.
Source. #9391, eff 2-21-09; amd by #9890-A, eff 3-22-11,
(paras (a) & (d)-(l)); amd by #9890-B,
eff 3-22-11, (paras (b) & (c)) ; ss by #12859, eff 8-28-19
PART
He-M 526 DESIGNATION OF RECEIVING FACILITIES
FOR DEVELOPMENTAL SERVICES
Statutory
Authority: RSA 171-A:20
He-M 526.01 Purpose. The purpose of these rules is to outline
standards and procedures for the designation and operation of receiving
facilities for voluntary and involuntary treatment of persons with developmental
disabilities.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 526.02 Definitions.
(a)
“Applicant” means that legal entity which requests designation as a
receiving facility.
(b) “Commissioner” means the commissioner of the
department of health and human services, or his or her designee.
(c)
“Department” means the New Hampshire department of health and human
services.
(d)
“Designated receiving facility (DRF)” means a residential treatment
program designated by the commissioner pursuant to RSA 171-A:20 and He-M 526 to
provide care, custody, and treatment to persons voluntarily and involuntarily
admitted to the state developmental services system.
(e)
“Designation” means a decision by the commissioner that a facility that
has not been operating as a DRF immediately prior to its application is
approved to operate as a DRF pursuant to He-M 526.
(f)
“Individual” means a person who is receiving the services of a DRF and:
(1) Receives services from a department-funded
developmental services program; or
(2) Receives the services of a DRF pursuant to
involuntary admission.
(g)
“Individual treatment plan” means a plan developed by the individual’s
treatment team to address the individual’s clinical needs and the behavior or
condition that creates a potential danger for others.
(h)
“Involuntary admission” means admission of a person to a DRF on an
involuntary basis per order of a probate court pursuant to RSA 171-B:12.
(i)
“Redesignation” means a decision by the commissioner that a DRF whose
designation is effective and that has applied for redesignation is approved to
continue to operate as a DRF pursuant to He-M 526.
(j)
“Region” means a geographic area designated pursuant to He-M 505.04 for
the purpose of providing services to individuals with developmental disabilities.
(k)
“Risk assessment” means an evaluation administered pursuant to He-M
503.09 (d)(13) using evidence-based tools to evaluate an individual’s behaviors
and determine the potential risks to the individual or others posed by said
behaviors.
(l)
“Risk management plan” means a person-centered document that describes
the services, supports, approaches and guidelines to be utilized to meet the individual’s
needs and mitigate risks to community safety and which is consistent with the service
guarantees and protections articulated in He-M 503.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 526.03 Designation Requirements.
(a) Pursuant to RSA 171-A:20, a DRF shall be
designated for one or more of the following purposes:
(1) To receive persons for involuntary admission
directly pursuant to a court order; and
(2) To receive involuntarily admitted persons by
transfer with the approval of the commissioner.
(b)
In addition to the purposes identified in (a) above, a DRF may receive
persons by voluntary admission if the DRF has the capacity to meet those persons’
needs.
(c)
A DRF shall comply with all requirements of these rules and He-M 310, He-M
503, He-M 507, He-M 522, He-M 1001, He-M 1201 and any other applicable rules adopted
by the commissioner.
(d)
A DRF shall:
(1) Provide services to clients regardless of their
ability to pay; and
(2) Assure that all services are provided in the
same manner and are of the same quality as services provided to other clients
pursuant to He-M 526.07.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 526.04 Establishment of a State DRF. If the commissioner establishes a
state-operated program as a DRF that has the administrative supports, clinical
services, and security measures to meet the needs of individuals served in the
facility, such DRF shall comply with the applicable provisions of He-M 526
through He-M 529.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08, EXPIRED: 1-3-16
New. #11125, eff 7-1-16
He-M 526.05 Designation and Redesignation Process for
a Community DRF.
(a) Application for designation or redesignation
as a community DRF shall be made in writing to the commissioner by an area
agency or subcontractor of an area agency, or through a request for proposals
process established by the department, and include the following:
(1) The name and address of the applicant;
(2) The physical location of the DRF;
(3) A statement
describing the capacity of the applicant to provide services pursuant to this
chapter;
(4) A description
of staffing patterns and staff qualifications, including clinical staff, that
demonstrates compliance with He-M 526.06;
(5) A description of all programs and services operated
by the applicant, including services to be available through the proposed DRF;
and
(6) A description of unmet service needs that the
proposed DRF would address.
(b)
An application for designation or redesignation shall include
documentation demonstrating that the DRF is eligible for licensure by the
department in accordance with RSA 151 and certification as a community
residence pursuant to He-M 1001, as applicable.
(c)
Application for redesignation shall be submitted by a community DRF to
request redesignation or to alter the service capacity or type of services a
DRF is designated to provide.
(d)
Application to request redesignation shall be submitted to the
commissioner at least 2 months prior to the expiration date of the DRF’s
designation.
(e)
Submission of an application pursuant to (d) above shall cause the DRF’s
current designation to be effective until the commissioner issues a decision
pursuant to (h) below.
(f)
The commissioner shall assign staff to review the application materials
and conduct a site visit of a program proposed for designation or
redesignation.
(g)
The review and site visit pursuant to (f) above shall be completed
within 60 days of the date of receipt of application and shall result in a
determination of the compliance or non-compliance of the DRF with He-M 526,
He-M 310, He-M 503, He-M 507, He-M 522, He-M 1001, He-M 1201, and all other
applicable department rules.
(h)
Within 10 days of completion of a review and site visit pursuant to (f)
and (g) above, the commissioner shall:
(1) Designate or redesignate as a DRF those
facilities that have been determined to be in compliance with He-M 526 and all other
applicable rules; or
(2) Deny designation or redesignation as a DRF to
those facilities that have been determined not to comply with He-M 526 or any
other applicable rules.
(i)
The commissioner shall notify an applicant in writing upon approval or denial
of application for designation or redesignation.
(j)
Designation or redesignation shall be effective for one year from the
date that notification is sent.
(k)
A DRF shall be designated or redesignated to provide only those services
described by the applicant pursuant to (a) above and those required pursuant to
He-M 526.07.
(l)
Notification of a decision to deny designation or redesignation shall
occur pursuant to He-M 526.09(a).
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08, EXPIRED: 1-3-16
New. #11125, eff 7-1-16
He-M 526.06 Staffing.
(a)
Staff of a DRF shall include:
(1) A DRF administrator who shall be responsible
for the overall operation of the DRF;
(2) A clinical director who shall be responsible
for all services provided to individuals admitted to the DRF; and
(3) Such clinicians as are necessary to meet the
treatment needs of the individuals served.
(b)
Clinicians working at a DRF may be employed on a full-time, part-time,
or consultant basis.
(c)
Professional staff of a DRF who provide psychotherapy shall meet the
requirements of He-M 426.08.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 526.07 Services to be Provided.
(a)
The following shall be basic services available to all individuals
served at a DRF:
(1) Psychological and other clinical evaluations,
including alcohol or substance abuse evaluations, as determined necessary by an
individual’s treating clinicians;
(2) Medical monitoring and medication
administration in accordance with He-M 1201;
(3) Individual and group therapeutic services
directed toward addressing each individual’s problem behaviors;
(4) Case coordination provided by DRF staff,
including individual evaluation, individual treatment planning, discharge
planning, and linkage with appropriate community services;
(5) Case management provided by area agency
staff;
(6) A functional assessment of each individual’s
community and independent living skills; and
(7) Instruction in
community and independent living skills to prepare each individual for discharge,
as specified in the individual’s treatment plan.
(b)
A DRF shall have adequate facilities to:
(1) Meet the treatment needs of the individuals
served, including provision of specialized evaluation and treatment;
(2) Afford all individuals access to all
programs, services, and physical facilities of the DRF in accordance with the
Americans with Disabilities Act; and
(3) Provide services such that language barriers
are overcome.
(c)
A DRF shall have an interagency agreement with the area agency in the
individual’s region of origin or other area agency as agreed to in the service
planning process. Such an agreement
shall address the responsibilities of the DRF and the area agency including, at
a minimum:
(1) Treatment planning in accordance with He-M
503;
(2) Risk assessment administration;
(3) Risk management plan development; and
(4) Discharge planning responsibilities of the area
agency and DRF.
(d)
A risk assessment shall be administered for each individual immediately
prior to, or within 30 days after, admission to a DRF, and a risk management
plan shall be developed by the area agency based on the risk assessment.
(e)
A DRF shall adopt policies and procedures governing seclusion and
restraint that shall be consistent with He-M 310.
(f)
A DRF shall adopt policies and procedures for a multi-level review for
the development of recommendations for absolute and conditional
discharges. Such policies and procedures
shall specify the nature and extent of participation by clinical staff in the
multi-level reviews.
(g)
A DRF shall provide ongoing contact with individuals on conditional
discharge status from the DRF and assist the area agency responsible for supporting
the individual on conditional discharge to facilitate the success of the
discharge plan.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 526.08 Safety Procedures.
(a)
A DRF shall have written procedures:
(1) Regarding supervision levels and the
monitoring of individuals, including the use of electronic or other security
devices;
(2) For accessing police and fire
department and emergency medical technician (EMT) services; and
(3) For the investigation, review, and
remediation of accidents, injuries, and safety hazards.
(b)
A DRF shall have an emergency evacuation plan that ensures the rapid
evacuation of the facility in the event of fire or other life threatening emergencies.
(c)
A DRF shall house non-ambulatory individuals in wheelchair-accessible
areas only, consistent with the Americans with Disabilities Act.
(d) A community DRF shall have comprehensive
liability insurance against all claims of bodily injury, death, or property
damage in amounts not less than $250,000 per claim and $2,000,000 per incident.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 526.09 Denial and Revocation of Designation.
(a)
Application for designation shall be denied or designation shall be
revoked, following written notice and opportunity for a hearing pursuant to
He-M 526.11, due to:
(1) Failure to maintain the necessary license or
certification pursuant to RSA 151 or He-M 1001;
(2) Failure to comply with these rules or any
applicable department rule;
(3) The DRF
administrator or applicant failing to provide information requested by the
department or knowingly giving false or misleading information to the department;
(4) Refusal by DRF staff to admit any employee of
the department of health and human services authorized to monitor or inspect
the facility in accordance with He-M 1001.14;
(5) Any reported abuse, neglect, or exploitation
of individuals by DRF personnel, if:
a. Such personnel have not been prevented from
having individual contact; and
b. Such abuse,
neglect, or exploitation is founded based on a protective investigation
performed by the department in accordance with He-E 700 and an administrative
hearing held pursuant to He-C 200, if such a hearing is requested;
(6) Felony conviction of any staff member of the
DRF;
(7) Misdemeanor conviction of any staff member of
the DRF involving:
a. Physical or sexual assault;
b. Violence;
c. Exploitation;
d. Child pornography;
e. Threatening or reckless conduct;
f. Driving under the influence of drugs or
alcohol;
g. Theft; or
h. Any other conduct that represents evidence of
behavior that could endanger the well-being of an individual; or
(8) Any illness or behavior of an applicant or
program staff member that, as evidenced by the documentation obtained and the
observations made by the department, would endanger the individuals’ well-being
or prohibit the DRF from complying with He-M 526 or other applicable rules, except
in cases where such program staff have been re-assigned and the individuals’
well-being and the DRF’s ability to comply with these rules are no longer at
risk.
(b)
Revocation shall only occur following:
(1) Provision of 30 days’ written notice by the commissioner
to the DRF of the specific rule(s) with which that DRF does not comply; and
(2) Opportunity, pursuant to He-M 526.11, for the
DRF to show compliance.
(c)
If, after notice and opportunity for hearing, the commissioner determines
that a DRF meets any of the criteria for revocation listed in (a)(1)-(8) above,
the commissioner shall revoke the designation of that program.
(d)
The commissioner shall withdraw a notice of revocation if, within the
notice period, the DRF complies with the specified rule(s).
(e)
Pending compliance with all requirements for designation specified in
written notice made pursuant to (b)(1) above, a DRF shall not accept additional
individuals if a notice of revocation has been issued concerning a violation that
poses potential danger to the health or safety of the individuals.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 526.10 Emergency Suspension of Designation.
(a)
If the commissioner finds at any time that the health, safety, or
welfare of individuals or the public is endangered by the continued operation
of a community DRF, the commissioner shall suspend that facility’s designation
immediately upon written notice specifying the reasons for the action.
(b)
A suspension shall be effective upon issuance.
(c)
At the time that the commissioner suspends the designation of a DRF, the
commissioner shall schedule, and give the DRF written notice of, a hearing to
be held within 10 working days.
(d) The purpose of the hearing referenced in (c)
above shall be to determine whether the DRF in fact posed an immediate and serious
threat to the health and safety of the individuals residing in the DRF at the
time its designation was suspended.
(e) The DRF shall also be afforded the opportunity
to show that since the time that its designation was suspended it has come into
compliance with all applicable rules adopted by the commissioner and no longer
poses an immediate and serious threat to the health or safety of the
individuals residing in the DRF.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff
7-1-16
He-M 526.11 Hearings.
(a)
An applicant or DRF shall have the right to request a hearing regarding
a proposed revocation or denial of designation, except that hearings on
emergency suspension of designation shall be mandatory.
(b)
Hearings shall be held in accordance with RSA 541-A and He-C 200.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 526.12 Waivers.
(a)
An applicant or DRF may request a waiver of specific procedures outlined
in He-M 526 by working with the area agency to complete and submit the form
titled “NH Bureau of Developmental Services Waiver Request” (September 2013
edition).
(b) A completed waiver request form submitted by
an applicant or DRF shall be signed by:
(1) The individual, guardian, or representative
indicating agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c) A waiver request shall be submitted to:
Office of Client
and Legal Services
State Office Park
South
105 Pleasant Street,
Main Building
Concord, NH 03301
(d)
No provision or procedure prescribed by statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner if the
alternative proposed by the applicant or DRF meets the objective or intent of
the rule and it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not negatively affect the quality of
services to individuals.
(f)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(g)
Upon receipt of approval of a waiver request, the applicant’s or DRF’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(h)
Waivers shall be granted in writing for a specific duration not to
exceed 5 years except as in (i) below.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
An applicant or DRF may request a renewal of a waiver from the
department in accordance with (a) through (c) above. Such request shall be made at least 90 days
prior to the expiration of a current waiver.
Source. #6213, eff 3-30-96, EXPIRED: 12-31-98
New. #7089, eff 8-31-99, EXPIRED: 8-31-07
New. #9059, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
PART He-M 527 ADMISSION TO AND DISCHARGE FROM A
DEVELOPMENTAL SERVICES DESIGNATED RECEIVING FACILITY
Statutory
Authority: New Hampshire RSA 171-A:3,
RSA 171-A:8-a
He-M 527.01 Purpose. The purpose of these rules is to establish
criteria and procedures for admission to and discharge from a developmental
services designated receiving facility (DRF).
Source. #6214, eff 3-30-96, EXPIRED: 12-31-98
New. #7062, eff 7-24-99, EXPIRED: 7-24-07
New. #9060, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 527.02 Definitions.
(a)
“Bureau administrator” means the chief administrator of the bureau of
developmental services.
(b)
“Commissioner” means the commissioner of the department of health and
human services or his or her designee.
(c)
“Conditional discharge” means the release of a person from a designated
receiving facility (DRF) during a period of court-ordered involuntary admission
on the condition that the person complies with specific provisions of
community-based treatment or is subject to readmission to the DRF.
(d)
“Department” means the New Hampshire department of health and human
services.
(e)
“Designated receiving facility (DRF)” means a residential treatment
program designated by the commissioner pursuant to RSA 171-A:20 and He-M 526 to
provide care, custody, and treatment to persons voluntarily and involuntarily admitted
to the state developmental services system.
(f)
“DRF administrator” means the staff member responsible for the overall
operation of a designated receiving facility, or his or her designee.
(g)
“Individual” means a person who is receiving the services of a DRF and:
(1) Receives services from a department-funded
developmental services program; or
(2) Receives the services of a DRF pursuant to
involuntary admission.
(h)
“Involuntary admission” means admission of a person to a DRF on an involuntary
basis per order of the probate court pursuant to RSA 171-B:12.
(i)
“Least restrictive alternative” means the program or service which least
inhibits a person’s freedom of movement and participation in the community and
accommodates the person’s informed decision-making while achieving the purposes
of treatment.
(j)
“Physician” means a medical doctor licensed to practice in New
Hampshire.
(k)
“Probate court” means the state court which has authority to preside
over civil commitment and guardianship proceedings.
(l)
“Voluntary admission” means admission to a DRF subsequent to the
documented consent of the person being admitted or his or her legal guardian.
Source. #6214, eff 3-30-96, EXPIRED: 12-31-98
New. #7062, eff 7-24-99, EXPIRED: 7-24-07
New. #9060, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 527.03 Admission to a DRF.
(a)
Pursuant to RSA 171-B:2, a person shall be involuntarily admitted when:
(1) The person has been charged with a felony
involving serious bodily injury or the use of a deadly weapon, or with aggravated
felonious sexual assault other than pursuant to RSA 632-A:2, I(h), or with
felonious sexual assault, or with arson pursuant to RSA 634:1, II or III;
(2) A district court, superior court, or grand
jury has found that probable cause exists that the person committed a felony as
set forth in (1) above;
(3) The person is determined to be not competent
to stand trial;
(4) The person has an intellectual disability, as
defined in the most current edition of the Diagnostic Manual-Intellectual
Disability developed by the National Association for the Dually Diagnosed in
association with the American Psychiatric Association; and
(5) The person has a condition or behavior as a
result of which the person poses a potentially serious likelihood of danger to
others or a potentially serious threat of engaging in acts which would
constitute arson as evidenced by a specific act or actions which may include
such act or actions giving rise to the felony charge according to RSA 171-B:2,
I.
(b)
Involuntary admissions shall not occur unless ordered by a probate court
pursuant to RSA 171-B:12.
(c)
A DRF shall not refuse admission of a person sent to such DRF pursuant
to RSA 171-B.
(d)
A person may be admitted to a DRF on a voluntary basis provided that:
(1) The person receives services through an area
agency;
(2) The person or his or her guardian has
provided a written document agreeing to the person’s placement at the DRF;
(3) The DRF has the capacity to meet the person’s
needs; and
(4) The DRF is the least restrictive, most
appropriate setting to meet the person’s needs and the placement has been
approved by the individual’s area agency human rights committee.
Source. #6214, eff 3-30-96, EXPIRED: 12-31-98
New. #7062, eff 7-24-99, EXPIRED: 7-24-07
New. #9060, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff
7-1-16
He-M 527.04 Transfers to or from a DRF.
(a)
A DRF may accept the transfer of a person who is admitted to the secure psychiatric
unit pursuant to RSA 171-B, in accordance with RSA 622:48, I(b).
(b)
A DRF may transfer a person admitted to the DRF pursuant to RSA 171-B,
to the secure psychiatric unit pursuant to RSA 171-B:15, I, RSA 622:45, and
He-M 611.
(c)
Transfers from one DRF to another shall be conducted in accordance with
He-M 529.
(d)
Transfers from a DRF for medical treatment or security reasons shall be
conducted in accordance with He-M 529.
Source. #6214, eff 3-30-96, EXPIRED: 12-31-98
New. #7062, eff 7-24-99, EXPIRED: 7-24-07
New. #9060, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125,
eff 7-1-16
He-M 527.05 Discharge of a Person Voluntarily Admitted.
(a) If a person is at a DRF on a voluntary basis,
he or she, or his or her legal guardian may request withdrawal from the DRF
whether or not such withdrawal is made against the advice of the DRF treatment
staff.
(b)
A person or legal guardian of a person who wishes to withdraw shall
state such intent in writing to staff of the DRF.
(c)
The time and date of receipt of a notice of intent to withdraw shall be
indicated on the notice, if applicable, and in the person’s medical record.
(d)
A person who has requested withdrawal or whose legal guardian has
requested withdrawal shall be discharged by a DRF within 24 hours of receipt of
such request, excluding weekends and holidays.
(e)
A person admitted to the DRF on a voluntary basis may be discharged
without requesting it if the staff of the DRF determine that the person’s needs
can be met in a less restrictive setting.
Source. #6214, eff 3-30-96, EXPIRED: 12-31-98
New. #7062, eff 7-24-99, EXPIRED: 7-24-07
New. #9060, eff 1-3-08 (from He-M 527.04); ss by
#11009, INTERIM, eff 1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 527.06 Discharge of a Person Involuntarily
Admitted.
(a)
If a person is admitted to a DRF subsequent to an involuntary admission,
such involuntary admission shall not continue beyond the time allowed by the
probate court order.
(b)
Pursuant to RSA 171-A:21, any person involuntarily admitted to a DRF
pursuant to RSA 171-B, or conditionally discharged pursuant to RSA 171-B, may
be granted absolute discharge by the DRF administrator most recently providing
services if the bureau administrator, or his or her designee:
(1) After reviewing the person’s situation, has
consented to the discharge; and
(2) Has determined that an absolute discharge
will not create a potentially serious likelihood of danger to others or
substantial damage to real property.
(c)
Upon the absolute discharge of any person from a DRF pursuant to He-M
527.06(b), the DRF administrator shall immediately, and in writing, notify the
person’s legal guardian, if any, the probate court entering the original order
of commitment, and the attorney general that an absolute discharge has been
granted to the person.
(d)
Any person who has been involuntarily admitted to a DRF may be
conditionally discharged under the conditions specified in He-M 528.
Source. #6214, eff 3-30-96, EXPIRED: 12-31-98
New. #7062, eff 7-24-99, EXPIRED: 7-24-07
New. #9060, eff 1-3-08 (from He-M 527.05); ss by
#11009, INTERIM, eff 1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 527.07 Waivers.
(a)
A DRF may request a waiver of specific procedures outlined in He-M 527
by working with the area agency to complete and submit the form titled “NH Bureau
of Developmental Services Waiver Request” (September 2013 edition).
(b) A completed
waiver request form submitted by an applicant or DRF shall be signed by:
(1) The individual, guardian, or representative
indicating agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c)
A waiver request shall be submitted to:
Office of Client
and Legal Services
State Office Park
South
105 Pleasant
Street, Main Building
Concord, NH 03301
(d) No provision or procedure prescribed by
statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner if the
alternative proposed by the DRF meets the objective or intent of the rule and
it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not negatively affect the quality of
services to individuals.
(f)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(g)
Upon receipt of approval of a waiver request, the DRF’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(h) Waivers shall be granted in writing for a
specific duration not to exceed 5 years except as in (i) below.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
A DRF may request a renewal of a waiver from the department in
accordance with (a) through (c) above.
Such request shall be made at least 90 days prior to the expiration of a
current waiver.
Source. #9060, eff 1-3-08 (from He-M 527.06) ); ss by
#11009, INTERIM, eff 1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
PART He-M 528 CONDITIONAL DISCHARGE FROM A DESIGNATED
RECEIVING FACILITY FOR DEVELOPMENTAL SERVICES
Statutory
Authority: RSA l71-A:21-24
He-M 528.01 Purpose. The purpose of these rules is to define the
criteria and procedures for conditional discharge of a person involuntarily
admitted to a designated receiving facility (DRF) and for the revision and revocation
of the conditional discharge.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.02 Definitions.
(a)
“Bureau administrator” means the chief administrator of the bureau of
developmental services.
(b)
“Commissioner” means the commissioner of the department of health and
human services or his or her designee.
(c)
“Conditional discharge” means the release of a person from a designated
receiving facility (DRF) during a period of court ordered involuntary admission
on the condition that the person comply with specific provisions of
community-based treatment or be subject to readmission to the DRF.
(d)
“Department” means the New Hampshire department of health and human
services.
(e) “Designated receiving facility (DRF)” means a
residential treatment program designated as a receiving facility by the
commissioner pursuant to RSA 171-A:20 and He-M 526 to provide care, custody,
and treatment to persons voluntarily and involuntarily admitted to the state
developmental services system.
(f)
“DRF administrator” means the staff member responsible for the overall
operation of a designated receiving facility, or his or her designee.
(g)
“Individual” means a person who is receiving the services of a DRF and:
(1) Receives services from a department-funded
developmental services program; or
(2) Receives the services of a DRF pursuant to
involuntary admission.
(h)
“Informed decision” means a choice made voluntarily by a resident of a
DRF or, where appropriate, such person’s legal guardian, after all relevant
information necessary to making the choice has been provided, when:
(1) The person understands that he or she is free
to choose or refuse any available alternative;
(2) The person clearly indicates or expresses his
or her choice; and
(3) The choice is free from all coercion.
(i)
“Involuntary admission” means admission of a person to a DRF on an
involuntary basis per order of a probate court pursuant to RSA l71-B:12.
(j)
“Law enforcement officer” means “officer” as defined in RSA 594:1, III.
(k)
“Treatment team member” means a person who shares ongoing responsibility
for the care and treatment of an individual.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.03 Grant of Conditional Discharge.
(a)
A recommendation for conditional discharge of a person shall be made by
the DRF administrator to the bureau administrator only after the following
actions have been taken:
(l) A multi-level review has occurred that:
a. Incorporates:
1. Clinical input;
2. Individual input; and
3. With the consent of the individual or his or
her guardian, the individual’s family’s input; and
b. Involves DRF staff and the staff of the
accepting area agency;
(2) The DRF staff and accepting area agency
concur that the supervision, treatment, and other services that the individual
needs can be provided by the accepting area agency; and
(3) The executive director of the area agency
where the individual will reside following conditional discharge has certified
that the supervision, treatment, and other services that the individual
requires will be provided.
(b)
The DRF administrator shall, with the prior approval of the bureau
administrator, grant a conditional discharge to a person who has been
involuntarily admitted to the DRF pursuant to RSA l71-B:12 when the following
criteria have been met:
(l) The person’s potential for danger to others
can be adequately mitigated through provision of ongoing care including
environmental modifications and staff supervision;
(2) A recommendation for conditional discharge of
the person has been made in accordance with the procedures in (a) above; and
(3) The person makes an informed decision to
agree to the conditions and terms of conditional discharge, including any
requirement for participation in continuing treatment in the community, and
agrees to be subject to the provisions of RSA 171-A:23 and He-M 528.
(c) Prior approval shall be given verbally or in
writing, after consideration of the facts upon which the conditional discharge
was based, if the bureau administrator determines that the criteria identified
in (b) above have been met.
(d)
The DRF administrator shall:
(1) Inform the person and his or her guardian, if
any, orally and in writing, in clear and understandable language, of:
a. The terms and conditions of discharge; and
b. The criteria and process for revocation of
conditional discharge; and
(2) Document the person’s consent to the elements
discussed pursuant to (1) above.
(e) The term of conditional discharge of a person
from a DRF granted under He-M 528 shall not exceed the period of time remaining
on the person’s order of involuntary admission made pursuant to RSA l71-B:12.
(f)
A conditional discharge may be:
(1) Made absolute in accordance with He-M 528.04;
(2) Revised in accordance with the provisions of
He-M 528.06; or
(3) Revoked in accordance with He-M 528.07.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.04 Grant of Absolute Discharge.
(a)
The administrator of a DRF from which a person has been conditionally
discharged shall grant to such person an absolute discharge:
(1) At the end of the term of the conditional
discharge unless:
a. The discharge has been revoked previously in
accordance with RSA 171-A:23 and He-M 528.07; or
b. Another order of involuntary admission of the
person has been made pursuant to RSA l71-B:12; or
(2) When the bureau administrator has reviewed the
situation and determined that an absolute discharge will not create a
potentially serious likelihood of danger to others or a potentially serious
likelihood of substantial damage to real property.
(b)
A notice of absolute discharge shall be given verbally or in writing,
after consideration of the facts upon which the absolute discharge was based, if
the bureau administrator determines that the criteria identified in (a)(1) or
(2) above have been met.
(c)
The DRF administrator shall, in writing, immediately notify the court
that made the original order of involuntary admission pursuant to RSA l71-B:12
and the attorney general that the person has been granted an absolute
discharge.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.05 Transfer to Another DRF. A person who so consents may be transferred
from one DRF to another for the purpose of being conditionally discharged. Such a transfer shall be in accordance with
He-M 529 and RSA 171-B:15, II.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.06 Revision of Conditions of Discharge from a
DRF. The term and conditions of a
conditional discharge granted pursuant to He-M 528.03 may be revised at any
time in accordance with the following procedures:
(a)
The revisions shall be proposed by the area agency serving the person
conditionally discharged, the person conditionally discharged, or the DRF from
which the person was conditionally discharged by forwarding a written request
from the proposing party to the other parties;
(b)
The DRF administrator shall immediately inform the bureau administrator
of any proposed revisions of the discharge conditions;
(c)
The person’s treatment team shall meet to consider and make a recommendation
regarding the proposed revisions;
(d)
Any proposed revisions shall be in writing and be signed by:
(1) The person subject to the conditional
discharge;
(2) The guardian, if any;
(3) The DRF administrator; and
(4) The area agency executive director or
designee;
(e)
The bureau administrator shall approve the revision after consideration
of the facts upon which the revisions were based if he or she determines that
the criteria identified in He-M 528.03 (b)(1) and (3) and (c)–(d) above have
been met;
(f)
Upon approval by the bureau administrator, the revised conditions shall
become effective until such time as:
(1) The order of involuntary admission expires;
(2) The conditional discharge is revoked or
revised; or
(3) The individual is absolutely discharged; and
(g)
Copies of the revised conditions shall be filed in the person’s clinical
record at the area agency and provided to:
(1) The person;
(2) The guardian, if any; and
(3) The DRF from which the person was conditionally
discharged.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.07 Revocation of Conditional Discharge.
(a)
An executive director or designee of an area agency providing continuing
treatment to a person conditionally discharged pursuant to He-M 528.03 shall,
after the review conducted pursuant to He-M 528.07 (b) and (c) below, temporarily
revoke a person’s conditional discharge if it is determined that:
(1) The person has violated a condition of the
discharge; and
(2) A condition or behavior exists as a result of
which the person might pose a potentially serious likelihood of danger to
others or a potentially serious threat of substantial damage to real property.
(b)
Before temporarily revoking a conditional discharge pursuant to He-M
528.07 (a), the area agency executive director or designee shall conduct a
review of the acts, behavior, or condition of the person to determine if one of
the criteria set forth in He-M 528.07 (a) is met.
(c)
Prior to the review, the person shall be given written and oral notice
of the claim, and the specific reasons therefor, that a violation of a
condition of the discharge has occurred or that a condition or behavior exists
as a result of which the person might pose a potentially serious likelihood of
danger to others or a potentially serious threat of substantial damage to real
property.
(d)
If the person refuses to consent to the review authorized by He-M 528.07
(b), the executive director or other representative of the area agency may sign
a complaint to compel review.
(e)
Upon issuance of a complaint pursuant to (d) above, any law enforcement
officer shall be authorized and directed, pursuant to RSA 171-A:23, IV, to take
custody of the person and immediately deliver him or her to the place for
review specified in the complaint.
(f)
Following the review conducted pursuant to (b) above, the executive
director shall:
(1) Temporarily revoke the conditional discharge
if he or she finds that a violation of a condition of the discharge has
occurred or that a condition or behavior exists as a result of which the person
might pose a potentially serious likelihood of danger to others or a potentially
serious threat of substantial damage to real property;
(2) Identify the DRF to which the person is to be
delivered;
(3) Inform the person in writing of the specific
reasons for the revocation and the receiving facility to which the person is to
be delivered;
(4) Direct a law enforcement officer to take
custody of the person and deliver the person to the identified receiving
facility; and
(5) Notify the DRF administrator immediately by
telephone of the temporary revocation.
(g)
The law enforcement officer who takes custody of the person whose conditional
discharge has been temporarily revoked shall, pursuant to RSA 171-A:23, IV,
deliver the person, together with a copy of the notice of, and reasons for, the
temporary revocation of the conditional discharge, to the DRF identified in
accordance with (f) above.
(h)
Within 48 hours of the arrival at a DRF identified in accordance with
(f) above of a person whose conditional discharge has been temporarily revoked,
the area agency shall deliver or cause to be delivered to the DRF a copy of the
court order of involuntary admission and a copy of the terms of the conditional
discharge.
(i)
The administrator, or clinical director if designated by the
administrator, of the DRF to which a person has been returned shall:
(1) Review the reasons for
temporary revocation of the conditional discharge with the individual; and
(2) Revoke absolutely the conditional discharge
if the temporary revocation documents that:
a. The person has violated a condition of the
discharge; or
b. A condition or behavior exists as a result of
which the person might pose a potentially serious likelihood of danger to
others or a potentially serious threat of substantial damage to real property.
(j)
Within 72 hours, excluding holidays, of delivery of a person to a DRF
pursuant to (g) above:
(1) A review pursuant to (i)(1) above shall be
completed; and
(2) An administrator’s decision pursuant to
(i)(2) above shall be made.
(k)
The DRF administrator shall immediately provide written notice of the
following to a person whose conditional discharge has been absolutely revoked:
(1) The reason for the revocation; and
(2) The person’s right to appeal and right to
legal counsel as set forth in He-M 528.08.
(l)
Immediately upon absolute revocation, the DRF shall notify the attorney
designated by the department pursuant to He-M 528.08 (e) to provide counsel to
the individual regarding his or her right to appeal and his or her right to be
represented by an attorney.
(m)
The person whose conditional discharge has been absolutely revoked shall
be admitted to the DRF identified in accordance with (f) above and be subject
to the terms and conditions of the order of involuntary admission made pursuant
to RSA 171-B:12 as if such conditional discharge had not been granted.
(n)
Following the revocation of a conditional discharge, the treatment team
shall reconvene to consider revised terms or alternative supports, services,
and treatment that might allow for a subsequent conditional discharge.
(o)
Following a review pursuant to (b) above, an examination and review
pursuant to (i)(1) above, or an appeal pursuant to He-M 528.08, if it is
determined that the conditions for temporary revocation of conditional
discharge identified in (a)(2) or (i)(2) above do not apply, the person shall:
(1) Promptly be returned by the DRF to the
location where he or she was taken into custody; and
(2) Be subject to the term and provisions of
conditional discharge that were in effect prior to the temporary revocation of
the conditional discharge.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.08 Appeal of Revocation.
(a)
A person whose conditional discharge has been absolutely revoked
pursuant to He-M 528.07 (i) may appeal the decision to the bureau administrator,
notwithstanding the consent of the person’s guardian, if any. The person may request assistance from the DRF
in effecting the appeal.
(b)
The appeal request shall:
(l) Be in writing;
(2) State whether or not assistance of legal
counsel is requested at such a hearing;
(3) State whether or not the person is able to
pay for legal counsel if the assistance of counsel is requested; and
(4) Include such information related to the basis
for the appeal as the person, at the time, elects to offer.
(c)
The DRF shall submit the appeal to the bureau administrator together
with copies of all notices provided to the person pursuant to He-M 528.07 and
any other information relevant to the reasons for absolute revocation of the
conditional discharge.
(d)
If a hearing is requested, the hearing shall be conducted in accordance
with He-M 202.08 and He-C 200, and shall occur within 5 days, excluding
weekends and holidays, of the receipt of the request for hearing.
(e)
The bureau administrator shall obtain legal counsel for any person who
requests a hearing on the appeal and requests legal counsel.
(f)
Following a hearing, the bureau administrator shall, within 3 working
days, decide if the person either has violated a condition of the discharge or
if a condition or behavior exists as a result of which the person might pose a
potentially serious likelihood of danger to others or a potentially serious
threat of substantial damage to real property.
(g) In reaching a decision, the bureau
administrator shall only consider evidence presented at the hearing.
(h)
The burden shall be upon the administrator of the DRF who absolutely
revoked the conditional discharge to establish that the criteria for absolute
revocation of the conditional discharge are met by clear and convincing
evidence.
(i)
The decision made by the bureau administrator shall be in writing, state
the reasons for the decision, and be sent promptly to the person appealing, his
or her legal counsel, if any, and the DRF and area agency that initiated the
process to revoke the conditional discharge of the person.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 528.09 Waivers.
(a) A DRF may request a waiver of specific
procedures outlined in He-M 528 by working with the area agency to complete and
submit the form titled “NH Bureau of Developmental Services Waiver Request”
(September 2013 edition).
(b) A completed waiver request form submitted by
an applicant or DRF shall be signed by:
(1) The individual, guardian, or representative
indicating agreement with the request; and
(2) The area agency’s executive director or
designee recommending approval of the waiver.
(c)
A waiver request shall be submitted to:
Office of Client
and Legal Services
State Office Park
South
105 Pleasant
Street, Main Building
Concord, NH 03301
(d)
No provision or procedure prescribed by statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner if the
alternative proposed by the DRF meets the objective or intent of the rule and
it:
(1) Does not negatively impact the health or
safety of the individual(s); and
(2) Does not negatively affect the quality of
services to individuals.
(f)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(g)
Upon receipt of approval of a waiver request, the DRF’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(h)
Waivers shall be granted in writing for a specific duration not to
exceed 5 years except as in (i) below.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
A DRF may request a renewal of a waiver from the department in
accordance with (a) through (c) above.
Such request shall be made at least 90 days prior to the expiration of a
current waiver.
Source. #6215, eff 3-30-96, EXPIRED: 12-31-98
New. #7063, eff 7-24-99, EXPIRED: 7-24-07
New. #9061, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
PART He-M 529 TRANSFERS BETWEEN DESIGNATED RECEIVING
FACILITIES IN THE DEVELOPMENTAL SERVICES SYSTEM
Statutory Authority: RSA 171-A:8-a, I
He-M 529.01 Purpose. The purpose of these rules is to establish
the criteria and procedures for transfers of involuntarily admitted persons
between designated receiving facilities in the developmental services system.
Source. #6216, eff 3-30-96, EXPIRED: 12-31-98
New. #7090, eff 8-31-99, EXPIRED: 8-31-07
New. #9062, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 529.02 Definitions.
(a)
“Attorney” means a lawyer retained, employed, or appointed by a court to
represent an individual.
(b)
“Bureau administrator” means the chief administrator of the bureau of
developmental services.
(c)
“Commissioner” means the commissioner of the department of health and
human services or designee.
(d)
“Department” means the New Hampshire department of health and human services.
(e) “Designated receiving facility
(DRF)” means a residential treatment program designated as a receiving facility
by the commissioner pursuant to RSA 171-A:20 and He-M 526 to provide care,
custody, and treatment to persons voluntarily and involuntarily admitted to the
state developmental services system.
(f)
“DRF administrator” means the staff member responsible for the overall
operation of a designated receiving facility, or his or her designee.
(g)
“Guardian” means a person who is appointed by the court to make
decisions regarding the person or property, or both, of another person pursuant
to RSA 464-A.
(h)
“Individual” means a person who is receiving the services of a DRF and:
(1) Receives services from a department-funded
developmental services program; or
(2) Receives the services of a DRF pursuant to involuntary
admission.
(i)
“Involuntary admission” means admission of a person to a DRF on an
involuntary basis per order of a probate court pursuant to RSA 171-B:12.
Source. #6216, eff 3-30-96, EXPIRED: 12-31-98
New. #7090, eff 8-31-99, EXPIRED: 8-31-07
New. #9062, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 529.03 Treatment and Security Transfers.
(a)
Whenever a DRF has custody of a person for a period of involuntary
admission, the DRF administrator or the administrator’s designee shall order
the transfer of the person to another DRF under the circumstances and
procedures identified in (b)–(k) below.
(b)
Transfers for treatment purposes shall be ordered if a person’s condition
is such that the DRF that has custody cannot reasonably provide the treatment
required to stabilize or ameliorate the person’s condition.
(c)
Transfers pursuant to (b) above shall only occur after the DRF administrator
consults with the administrator of the proposed receiving DRF and determines
that it can provide the treatment the person requires.
(d)
Transfers for medical treatment at an acute care hospital shall be made
if the following conditions apply:
(1) The person has medical needs requiring
treatment that cannot be provided at the DRF;
(2) The hospital to which the person is to be
transferred can provide the treatment that the person requires; and
(3) One of the following conditions applies:
a. The person, or the person’s legal guardian if
the guardian has been granted decision-making authority regarding medical care,
has approved the transfer; or
b. A personal safety emergency exists pursuant
to He-M 305.03.
(e)
A person who is transferred for medical treatment shall remain under the
protective custody of the admitting DRF pursuant to the authority under which
the person was involuntarily admitted.
(f)
Transfers for security purposes shall be ordered if:
(1) A person’s behavior is such that the DRF that
has custody cannot reasonably provide the supervision and control necessary to
prevent the person from causing bodily harm to self or others or significant
damage to property; and
(2) The DRF administrator has determined that the
DRF to which the person is to be transferred can provide the supervision and
control the person requires.
(g)
No transfer shall occur under He-M 529.03 without the prior approval of the
bureau administrator.
(h)
Prior approval shall be given verbally or in writing, after
consideration of the facts upon which the transfer order was based, if the bureau
administrator determines that the criteria identified in (f) above have been
met.
(i)
When a transfer is to be made for treatment or security purposes, the
DRF administrator shall sign a transfer order stating the reasons for the
transfer and identifying the DRF to which the person is to be transferred.
(j)
The DRF administrator shall:
(1) Give to the person to be transferred:
a. A copy of the transfer order; and
b. A verbal explanation of the order, the transfer
procedures, and the right to object to the transfer; and
(2) Send a copy of the order to the person’s
guardian and attorney, if any, within 24 hours of issuance.
(k)
Within 48 hours of receipt of a transfer order, the bureau administrator
shall either approve the transfer if it is determined that the criteria identified
in (f) above have been met or disapprove the transfer.
(l)
Once transferred, a person shall be subject to RSA 171-B as if
originally placed in the custody of the DRF to which the person was
transferred, except as provided in (e) above.
(m)
Transportation of a person under this section shall be arranged by the
DRF making the transfer, as follows:
(1) The person may be transported by staff of the
DRF from which or to which the person is being transferred; or
(2) The person may be transported by any law
enforcement officer empowered to transport under RSA 171-A:27.
Source. #6216, eff 3-30-96, EXPIRED: 12-31-98
New. #7090, eff 8-31-99, EXPIRED: 8-31-07
New. #9062, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 529.04 Transfers to Less Restrictive Settings.
(a)
Whenever a DRF has custody of a person for a period of involuntary
admission, the DRF administrator shall order the transfer of the person to
another DRF if:
(1) The DRF to which the person will be transferred
can provide an environment that is less restrictive of the person’s freedom of
movement than the DRF having custody of the person; and
(2) The DRF to which the person will be
transferred can provide the care, treatment, and security required for the
person.
(b)
When a transfer is being made to a DRF with a less restrictive setting,
the administrator of the transferring DRF shall sign an order of transfer.
(c) The transfer order shall state the reason for
the transfer and identify the DRF to which the person is to be transferred.
(d)
The person to be transferred shall be given a copy of the transfer order
and a verbal explanation of the order, the transfer procedures, and the right
to object to the transfer.
(e)
A copy of the order shall also be sent to the person’s guardian or
attorney, if any.
(f)
Any transfer under He-M 529.04 shall require:
(1) Prior approval by the bureau administrator,
based upon a determination that the transfer criteria specified in (a) above
have been met; and
(2) Prior approval by the administrator of the
DRF to which the person is being transferred.
(g)
If a person being transferred under He-M 529.04 objects to the transfer,
the challenge shall be treated as an appeal in accordance with He-C 200, notwithstanding
the consent of the person’s guardian, if any.
(h)
Once transferred, a person shall be subject to RSA 171-B as if originally
placed in the custody of the DRF to which the person was transferred.
(i)
Transportation of a person under this section shall be arranged by the
DRF making the transfer, as follows:
(1) The person may be transported by staff of the
DRF from which or to which the person is being transferred; or
(2) The person may be transported by any law enforcement
officer empowered to transport under RSA 171-A:27.
Source. #6216, eff 3-30-96, EXPIRED: 12-31-98
New. #7090, eff 8-31-99, EXPIRED: 8-31-07
New. #9062, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 529.05 Emergency Transfers.
(a)
A person who has been admitted to a DRF by an involuntary admission
pursuant to RSA 171-B:12 shall, in the event that an emergency is determined to
exist pursuant to (b) below, be transferred to another DRF by the DRF
administrator without the prior approval of the bureau administrator.
(b)
A DRF administrator shall determine that an emergency exists when there is
serious likelihood of danger to the person or to others or a serious likelihood
of substantial damage to property if the transfer is not made and an immediate
transfer is necessary in order to protect the person or others.
(c)
The determination of a serious likelihood of danger shall be based upon
the behavior(s) of the person to be transferred or other circumstances that
create a strong probability that the person will cause or attempt to cause harm
to self or others, or will cause or attempt to cause substantial damage to
property and the DRF cannot reasonably provide the degree of safety and
security necessary to prevent the harm or the damage.
(d)
Prior to the emergency transfer of the person, the DRF administrator or
his or her designee shall:
(1) Inform the person verbally and in writing of the
transfer and reasons therefor; and
(2) Give the person an opportunity to consent to
the transfer.
(e)
The commissioner shall, within 24 hours, excluding Saturdays, Sundays and
holidays, of an emergency approve the transfer of the person if the criteria
identified in (b) above have been met.
(f)
If the approval referenced in (e) above is not granted within 24 hours
after the transfer, the person shall be immediately returned to the DRF from which
he or she was transferred.
(g)
If the commissioner approves the emergency transfer and the person
transferred has consented to the transfer, no further action shall be necessary
and the person will then be in the care and custody of the DRF to which he or
she has been transferred.
(h)
If the person being transferred objects to the transfer, the challenge
shall be treated as an appeal in accordance with He-C 200, notwithstanding the
consent of the person’s guardian, if any.
(i)
A hearing shall be conducted in accordance with the procedures set forth
in He-M 202.08 and He-C 200 within 72 hours, excluding Saturdays, Sundays and
holidays, after the transfer has been approved.
The review or hearing may occur following the transfer.
(j)
Following a hearing, the person shall promptly be returned to the DRF
from which he or she was transferred if the commissioner finds that an
emergency pursuant to (b) above did not exist.
Source. #6216, eff 3-30-96, EXPIRED: 12-31-98
New. #7090, eff 8-31-99, EXPIRED: 8-31-07
New. #9062, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
He-M 529.06 Waivers.
(a)
A DRF may request a waiver of specific procedures outlined in He-M 528 by
working with the area agency to complete and submit the form titled “NH Bureau
of Developmental Services Waiver Request” (September 2013 edition).
(b) A completed waiver request form submitted by
an applicant or DRF shall be signed by:
(1) The individual, guardian, or representative
indicating agreement with the request; and
(2) The area agency’s executive director or designee
recommending approval of the waiver.
(c)
A waiver request shall be submitted to:
Office of Client
and Legal Services
State Office Park
South
105 Pleasant
Street, Main Building
Concord, NH 03301
(d)
No provision or procedure prescribed by statute shall be waived.
(e)
The request for a waiver shall be granted by the commissioner if the
alternative proposed by the DRF meets the objective or intent of the rule and
it:
(1) Does not negatively impact the health or safety
of the individual(s); and
(2) Does not negatively affect the quality of
services to individuals.
(f)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(g)
Upon receipt of approval of a waiver request, the DRF’s subsequent
compliance with the alternative provisions or procedures approved in the waiver
shall be considered compliance with the rule for which waiver was sought.
(h)
Waivers shall be granted in writing for a specific duration not to exceed
5 years except as in (i) below.
(i)
Any waiver shall end with the closure of the related program or service.
(j)
A DRF may request a renewal of a waiver from the department in
accordance with (a) through (c) above.
Such request shall be made at least 90 days prior to the expiration of a
current waiver.
Source. #6216, eff 3-30-96, EXPIRED: 12-31-98
New. #7090, eff 8-31-99, EXPIRED: 8-31-07
New. #9062, eff 1-3-08; ss by #11009, INTERIM, eff
1-3-16, EXPIRES: 7-1-16; ss by #11125, eff 7-1-16
APPENDIX A: Incorporation by Reference Information
Rule |
Title |
Publisher; How to Obtain; and Cost |
He-M 503.02(r), He-M 503.08(b)(12)a., and He-M
503.09(o)(2) |
Health Risk Screening Tool (HRST) (2015 edition) |
Publisher: IntellectAbility Cost: 1–100 consumers = $699.00 each; 1–200
consumers = $899.00 each; 1–1000 consumers = $999.00 each The incorporated
document is available at https://replacingrisk.com/ |
He-M 503.02(t), 503.08(d)(10)a., 503.09(d)(12) |
Health Risk Screening Tool (HRST) (2015 edition) |
DTECH Computerists, Inc. PO Box 480942. Tulsa, OK
74148-0942. Voice: (918) 585-9988 x110. Toll free: (800) 800-4278 x110. Website: www.dtechgroup.com. Email: HRSTinfo@dtechgroup.com. Cost: 1–100 consumers = $699.00 each; 1–200
consumers = $899.00 each; 1–1000 consumers = $999.00 each |
He-M 503.02(am), He-M 503.08(b)(12)a., and He-M
503.09(o)(1) intro, c., and e. |
Supports Intensity Scale- Adult Version (SIS-A)
(2023 edition) |
Publisher: American Association on Intellectual and
Developmental Disabilities (AAIDD) Cost: $115 The incorporated document is available at:
https://www.aaidd.org/sis |
He-M
506.02(g) |
Health
Risk Screening Tool (HRST) (2009 edition) |
DTECH
Computerists, Inc. PO Box 480942. Tulsa, OK 74148-0942. Voice: (918) 585-9988
x110. Toll free: (800) 800-4278 x110.
Website: www.dtechgroup.com. Email: HRSTinfo@dtechgroup.com. Cost:
1–100 consumers = $699.00 each; 1–200 consumers = $899.00 each; 1–1000 consumers
= $999.00 each |
He-M
506.02(m) |
Supports
Intensity Scale (2004 edition) |
American
Association on Intellectual and Developmental Disabilities. 501 3rd St., NW,
Suite 200. Washington, D.C. 20001 Phone: 800-424-3688. Cost: $115 |
He-M 506.03(b)(5) |
Centers for Disease Control and Prevention,
“Guidelines for Preventing the Transmission of Tuberculosis in Health
Facilities/Settings, 2005” |
Publisher: US
Department of Health and Human Services, Centers for Disease Control and
Prevention. Available free of charge from the CDC website at www.cdc.gov, and more specifically: http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf
. |
He-M |
Health Risk Screening Tool (HRST) (2009 edition) |
DTECH Computerists, Inc. PO Box 480942. Tulsa, OK
74148-0942. Voice: (918) 585-9988 x110. Toll free: (800) 800-4278 x110. Website: www.dtechgroup.com. Email: HRSTinfo@dtechgroup.com. Cost: 1–100 consumers
= $699.00 each; 1–200 consumers = $899.00 each; 1–1000 consumers = $999.00
each |
He-M |
Supports Intensity Scale (2004 edition) |
American Association on Intellectual and
Developmental Disabilities. 501 3rd St., NW, Suite 200. Washington, D.C. 20001 Phone: 800-424-3688. Cost: $115 |
He-M 510.06(k)(5) |
The IDA Institute’s, “Infant-Toddler Developmental
Assessment-2 (IDA-2)” (Second Edition) |
Publisher: The
IDA Institute Cost: $90 for
packs of 25 The incorporated
document is available at: https://ida2.org/collections/ida-2-manuals-and-forms
|
He-M 510.06(k)(5) |
Shine Early Learning’s, “The Hawaii Early Learning
Profile (HELP) Strands 0-3” (1992-2013) |
Publisher: Shine
Early Learning Cost: $4.95
single booklet/ $106.25 pack of 25 booklets The incorporated
document is available at: https://shineearly.store/products/help-strands-0-3 |
He-M |
Supports Intensity Scale (2004 edition) |
American
Association on Intellectual and Developmental Disabilities. 501 3rd St., NW,
Suite 200. Washington, D.C. 20001 Phone:
800-424-3688. Cost: $115 |
He-M |
Health Risk Screening Tool (HRST) (2009 edition) |
DTECH
Computerists, Inc. PO Box 480942. Tulsa, OK 74148-0942. Voice: (918) 585-9988
x110. Toll free: (800) 800-4278 x110.
Website: www.dtechgroup.com. Email: HRSTinfo@dtechgroup.com. Cost: 1–100
consumers = $699.00 each; 1–200 consumers = $899.00 each; 1–1000 consumers =
$999.00 each |
He-M 518.10(h)(1)a. |
APSE Supported Employment Competencies (Revision
2010) |
Publisher: Association of People Supporting Employment
First (APSE). Available online
at no cost: http://www.apse.org/docs/APSE%20Supported%20Employment%20Competencies[1]1.pdf |
He-M 522.02(aa) |
Diagnostic and
Statistical Manual of Mental Disorders, (Fifth Edition, Text Revision)
(DSM-5) |
Available from the
publisher, American Psychiatric Publishing (http://www.appi.org/Home), a
division of the American Psychiatric Association (APA) (www.psychiatry.org). Cost is $155.00. |
He-M 522.02(s) |
Health Risk
Screening Tool (2015 edition) |
Available from
the publisher, http://hrstonline.com The cost of this
software is based on a “per individual” pricing model and is determined by the
number of individuals being rated. |
He-M 522.02(an) |
Supports Intensity Scale (January 2004 edition), |
Available from
the publisher, American Association on Intellectual and Developmental
Disabilities (https://aaidd.org/sis/)
Cost is $120.00. |
APPENDIX B
RULE |
SPECIFIC STATE
STATUTES WHICH THE RULE IMPLEMENTS |
|
|
He-M
501.01 |
RSA
171-A:30, 31 |
He-M
501.02 |
RSA
171-A:30, 31 |
He-M
501.03 |
RSA
171-A:30, 31 |
He-M
501.04 |
RSA
171-A:30, 31 |
He-M
501.05 |
RSA
171-A:30, 31 |
He-M
501.06 |
RSA
171-A:30, 31 |
He-M 503.01 |
RSA 171-A:4-8; 11-13; 18, I |
He-M 503.02 |
RSA 171-A:4-8; 11-13; 18, I |
He-M 503.03 |
RSA 171-A:4 |
He-M 503.04 |
RSA 171-A:5; 6, I |
He-M 503.05 |
RSA 171-A:6, II, III, IV |
He-M 503.06 |
RSA 171-A:6, II; 11 |
He-M 503.07 |
RSA 171-A:13; 14 |
He-M 503.08 |
RSA 171-A:11, I-II; 18; I |
He-M 503.09 |
RSA 171-A:11; 12; 42 CFR § 441.301(c)(1) |
He-M 503.10 |
RSA 171-A:11; 12; 42 CFR §441.301(c)(2) & (c)(4) |
He-M 503.11 |
RSA 171-A:11; 12; 18, I |
He-M 503.12 |
RSA 171-A:18, II |
He-M 503.13(a) intro & (a)(1) |
RSA 171-A:1-a |
He-M 503.14 |
RSA 171-A:6, I |
He-M 503.15 |
RSA 171-A:8 |
He-M 503.16 |
RSA 171-A:7 |
He-M 503.17 |
RSA 171-A:6, V |
He-M 503.18 |
RSA 171-A:3; 541-A:22, IV |
He-M 504.01 – 504.03 |
RSA 171-A:3; 18, IV |
He-M 504.04 |
RSA 171-A:3; 18, IV; 42 CFR § 455.410; 42 CFR § 447.10 |
He-M 504.05 |
RSA 171-A:3; 18, IV |
He-M 504.06 |
RSA 171-A:3, 18, IV; 42 CFR § 447.10 |
He-M 504.07 |
RSA 171-A:3; 42 CFR § 433.139 |
He-M 504.08 |
RSA 171-A:3; 18, IV |
He-M 504.09 |
RSA 171-A:3; 42 CFR § 455; 42 CFR § 456 |
He-M 504.10 |
RSA 171-A:3; 42 CFR § 455.14 |
He-M 504.11-504.14 |
RSA 171-A:3; 18, IV |
He-M 505.01 |
RSA 171-A:18; I, II; IV |
He-M 505.02 |
RSA 171-A:18; I, II; IV |
He-M 505.03 (Specific paragraphs implementing specific statutes are listed below) |
RSA 171-A:18; I, II; IV |
He-M 505.03 |
RSA 171-A:18; I, II; IV; 42 CFR 441.301; 42 CFR 447.10 |
He-M 505.03(a)-(ac) |
RSA 171-A:18; I, II; IV |
He-M 505.03 (o)-(s) |
RSA 171-A:18; III, IV |
He-M 505.03 (t)-(v) |
RSA 171-A:18; V |
He-M 505.04 |
RSA 171-A:18; I, III; IV; V, VI |
He-M 505.05 (Specific paragraphs implementing specific statutes are listed below) |
RSA 171-A:18; I, II; IV |
He-M 505.05 |
RSA 171-A:18, I, II; IV |
He-M 505.05(a)-(e)(3), (e)(5)-(8) |
RSA 171-A:18; I, II; IV |
He-M 505.05(e)(8) |
RSA 171-A:18; VII |
He-M 505.05 (e)(4), (f) & (g) |
RSA 171-A:18; I, II; IV |
He-M 505.06 (Specific paragraphs implementing specific statutes are listed below) |
RSA 171-A:18; I, II; IV |
He-M 505.06 |
RSA 171-A:18; I, II; IV |
He-M 505.06(a)-(e)(3), (e)(5)-(8) |
RSA 171-A:18; I, II; IV |
He-M 505.06(e)(8) |
RSA 171-A:18; VII |
He-M 505.06 (e)(4), (f) & (g) |
RSA 171-A:18; I, II; IV |
He-M 505.07 |
RSA 171-A:18; I, II; IV |
He-M 505.08 |
RSA 171-A:18; I, II; IV |
He-M 505.09 |
RSA 171-A:18; I, II; IV |
He-M 505.10 |
RSA 171-A:18; I, II; IV |
He-M 505.11 |
RSA 171-A:18; I, II; IV |
He-M 505.12 |
RSA 171-A:18; I, II; IV |
He-M 505.13 |
RSA 171-A:18; I, II; IV |
He-M 505.14 |
RSA 171-A:18; I, II; IV |
He-M 506.01 – 506.05 |
RSA 171-A:18; I, II; RSA 137-K:9 |
He-M 506.06 |
RSA 171-A:18; I, II; RSA 541-A:22, IV; RSA 137-K:9 |
He-M 507.01 – 507.12 |
RSA 171-A:18; I, II; RSA 137-K:9 |
He-M 507.08 |
RSA 171-A:18; I, II; RSA 137-K:9; RSA 161:4-a, XI |
He-M 507.09 – 507.12 |
RSA 171-A:18; I, II; RSA 137-K:9 |
He-M 507.13 |
RSA 171-A:18; I, II; RSA 541-A:29, 30, II; RSA
137-K:9 |
He-M 507.14 |
RSA 171-A:18; I, II; RSA 541-A:30, III; RSA 137-K:9 |
He-M 507.15 |
RSA 171-A:18; I, II; RSA 541-A:31, III; RSA 137-K:9 |
He-M 507.16 |
RSA 171-A:18; I, II; RSA 137-K:9 |
He-M 507.17 |
RSA 171-A:18; I, II; RSA 541-A:22, IV; RSA 137-K:9 |
He-M 510 All sections |
RSA 171-A:14, V (Specific provisions implementing
specific federal regulations are listed below) |
He-M 510.01 |
34 CFR Part 303.1-3 9/28/11, IDEIA, Part C |
He-M 510.02 |
34 CFR Part 303.4-37 9/28/11; IDEIA, Part C |
He-M 510.03 |
34 CFR Part 303.12-13 9/28/11, IDEIA, Part C |
He-M 510.04 |
34 CFR Part 303.13 9/28/11, IDEIA, Part C |
He-M 510.05 |
34 CFR Part 303.421 9/28/11, IDEIA, Part C |
He-M 510.06 |
34 CFR Part 303.303. 303.320-.322 9/28/11, IDEIA,
Part C; |
He-M 510.07 |
34 CFR Part 303.340-345, 9/28/11, IDEIA, Part
C; RSA 171-A:12 |
He-M 510.08 |
34 CFR Part 303.342 - 303.346, 9/28/11, IDEIA, Part
C; RSA 171-A:11 |
He-M 510.09 |
34 CFR Part 303.209 9/28/11, IDEIA, Part C |
He-M 510.10 |
RSA 171-A:18 IV; 34 CFR Part 303.401-417 303.209,
303.702, 303.720-724 9/28/11, IDEIA, Part C |
He-M 510.11 |
34 CFR Part 303.119 9/28/11; IDEIA, Part C |
He-M 510.12 |
34 CFR Part 303.118, 9/28/11; IDEIA, Part C |
He-M 510.13 |
34 CFR Part 303.401-417, 9/28/11; IDEIA, Part C |
He-M 510.14 |
34 CFR Part 303.510-511, 303.520-521; 9/28/11,
IDEIA, Part C |
He-M 510.15 |
34 CFR Part 303.600-605, 9/28/11, IDEIA, Part C |
He-M 510.16 |
34 CFR Part 303.117, 9/28/11, IDEIA, Part C |
He-M 510.17 |
RSA 541-A:22, IV |
He-M 510.18 |
34 CFR Part 303.422 |
He-M 513.01 |
RSA 171-A:18; I, II |
He-M 513.02 |
RSA 171-A:18; I, II; Sect. 1902(a)(10) and 1915(c)
SSA |
He-M 513.03 |
RSA 171-A:18; I, II |
He-M 513.04 |
RSA 171-A:18; I, II |
He-M 513.05 |
RSA 171-A:18; I, II |
He-M 513.06 |
RSA 171-A:18; V; RSA 126-G:4 |
He-M 513.07 |
RSA 171-A:18; I, II |
He-M 513.08 |
RSA 541-A:22, IV |
He-M 517 (all sections) |
RSA 171-A:18, I; RSA 137-K:9 |
He-M 518.01 – 518.11 |
RSA 171-A:18; I, II; RSA 137-K:9 |
He-M 518.12 |
RSA 171-A:18; I, II; RSA 541-A:22, IV; RSA 137-K:9 |
He-M 519.01 - 519.04 |
RSA 126-G:3 |
He-M 519.05 - 519.07 |
RSA 126-G:4 |
He-M 519.08 - 519.09 |
RSA 126-G:3 |
He-M 520.01 -
520.09 |
RSA 132:2, X;
RSA 132:13 |
He-M 521.01 -
521.14 |
RSA 171-A:4; 18,
I and II |
He-M 522.01 - 522.19 |
RSA 137-K:1 |
He-M 522.02 |
RSA 137-K:3, I, IV |
He-M 522.03 - 522.07 |
RSA 137-K:3, IV |
He-M 522.08 - 522.12 |
RSA 137-K:3, I, IV |
He-M 522.13 |
RSA 137-K:3, I, IV, RSA 171-A:1-a |
He-M 522.14 - 522.16 |
RSA 137-K:3, I, IV |
He-M 522.17 - 522.19 |
RSA 137-K:3, IX |
He-M 523.01 - 523.06 |
RSA 126-G:3; 161:2, I |
He-M 523.07 - 523.09 |
RSA 126-G:4; 161:2, I |
He-M 523.10 - 523.14 |
RSA 126-G:3; 161:2, I |
He-M 524.01 and He-M 524.02 |
RSA 161-I-1; RSA 171-A:I |
He-M 524.03 |
RSA 161-I:2, IV; RSA 171-A:4 |
He-M 524.04 - He-M 524.06 |
RSA 161-I:1; RSA 171-A:4 |
He-M 524.07 - He-M 524.16 |
RSA 171-A:3,4 |
He-M 524.17 |
RSA 161-I:1; RSA 171-A:3,4 |
He-M 524.18 |
RSA 161-I:1; RSA 171-A:4 |
He-M 524.19 - He-M 524.25 |
RSA 171-A:4 |
He-M 524.26 |
RSA 171-A:18, II; RSA 161-I:3-a |
He-M 524.27 |
RSA 171-A:3 |
He-M 525.01 |
171-A:1; 4-8; 11-13; 18, I |
He-M 525.02 |
171-A:4-8; 11-13; 18, I |
He-M 525.03 |
RSA 171-A:4 |
He-M 525.04 |
RSA 171-A:4; 12 |
He-M 525.05 |
RSA 171-A:13; 14 |
He-M 525.06 |
RSA 171-A:11; 12; 13 |
He-M 525.07 |
RSA 171-A:18, I, II |
He-M 525.08 |
RSA 171-A:11; 13 |
He-M 525.09 |
RSA 171-A:18, I, II |
He-M 525.10 |
RSA 171-A:1, V; 18, I, II |
He-M 525.11 |
RSA 171-A:6, V |
He-M 525.12 |
RSA 171-A:18, I, II |
He-M 525.13 |
RSA 171-A:3; RSA 541-A:22, IV |
He-M 526.01 – He-M 526.12 |
RSA 171-A:20 |
He-M 527.01 |
RSA 171-A:3 |
He-M 527.02 |
RSA 171-A:3 |
He-M 527.03 |
RSA 171-B:2 |
He-M 527.03(a)(4) |
RSA 171-B:2, IV |
He-M 527.04 |
RSA 171-A:8-a |
He-M 527.05 |
RSA 171-A:21 |
He-M 527.06 |
RSA 171-A:21 |
He-M 527.07 |
RSA 171-A:3 |
He-M 528.01 |
RSA 171-A:3 |
He-M 528.02 |
RSA 171-A:3 |
He-M 528.03 |
RSA 171-A:22 |
He-M 528.04 |
RSA 171-A:21, I |
He-M 528.05 |
RSA 171-A:8-a, I |
He-M 528.06 |
RSA 171-A:22 |
He-M 528.07 |
RSA 171-A:23 |
He-M 528.08 |
RSA 171-A:24 |
He-M 528.09 |
RSA 171-A:3 |
He-M 529.01 – 529.06 |
RSA 171-A:8-a; 171-B:15 |