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

 

          He-M 505.02  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; 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

 

          He-M 519.09  Waivers.

 

          (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)

 

          HeM 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

 

          He-M 524.02  Definitions.

 

          (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.
Website: http://www.aaidd.org/.  Email: bookstore@aaidd.org. 

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
507.02(n) & 507.08(e)(6)d.

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
507.02 (z) & 507.08(e)(6)a.

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.
Website: http://www.aaidd.org/.  Email: bookstore@aaidd.org. 

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
517.07(e)(6)a.

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.
Website: http://www.aaidd.org/.  Email: bookstore@aaidd.org. 

Cost:  $115

He-M
517.07(e)(6)d.

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).
46 Hungerford Dr, Suite 418, Rockville, MD 20850.
Phone: (301) 279-0060.  Fax: (301) 279-0075.

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;
RSA 171-A:6

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
(Specific sections implementing specific statutes are listed as below)

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