TABLE
OF CONTENTS
CHAPTER
He-W 400 SUPPORT OF DEPENDENT
CHILDREN
PART He-W 401 DEFINITIONS
Section He-W 401.01 Definitions
PART He-W 402 ESTABLISHING PATERNITY - EXPIRED
PART He-W 403 DISTRIBUTION AND DISBURSEMENT OF SUPPORT
PAYMENTS
Section He-W 403.01 Distribution
Section He-W 403.02 Disbursement
Section He-W 403.03 Recoupment of Overpayments
Section He-W 403.04 Recovery of Payments for Returned Child Support
Payment Checks and Reversed Electronic Payments Made by a Payor
Section He-W 403.05 Recovery of Payments for Returned Child
Support Payment Checks and Reversed Electronic Payments Made by an Employer
Section He-W 403.06 Recovery of Payments Resulting from an
Adjusted Federal Tax Return
Section He-W 403.07 Appeals and Review Process
PART He-W 404
Section He-W 404.01 Identification, Confirmation, and
Interception of Child Support Arrearages
Section He-W 404.02 Appeal Process
Section He-W 404.03 Distribution of Intercepted Lottery Prizes
Section He-W 404.04 Refund of Erroneously Intercepted Lottery
Prizes
PART He-W 405 FEES
Section He-W 405.01 Annual Fee for Services
Section He-W 405.02 Child Support Disbursement Fee – REPEALED
PART He-W 406 MANDATORY WAGE ASSIGNMENT - EXPIRED
PART He-W 407 ADMINISTRATIVE HEARINGS PROCESS - EXPIRED
PART He-W 408 CASE INITIATION - EXPIRED
Section He-W 408.01 Prioritization of Child Support Cases
PART He-W 409 CLOSURE OF CHILD SUPPORT CASES - EXPIRED
Section He-W 409.01 Criteria for Case Closure
PART He-W 410 APPEALS OF BUREAU OF CHILD SUPPORT SERVICES
ACTIONS AND DECISIONS
Section He-W 410.01 Appeals of Bureau of Child Support Services
Actions and Decisions
TABLE
OF CONTENTS
CHAPTER
He-W 500 MEDICAL ASSISTANCE
PART
He-W 501 GENERAL MEDICAL ELIGIBILITY –
EXPIRED
Section He-W 501.01 Definitions
Section He-W 501.02 Financial
Eligibility
Section He-W 501.03 Client or
Authorized Representative Responsibilities
Section He-W 501.04 Agency
Responsibilities
Section He-W 501.05 Exceptions
to Medical Examination Requirement
Section He-W 501.06 Failure or
Refusal to Obtain Information
Section He-W 501.07 Refusal of
Medical Treatment
Section He-W 501.08 Good Cause
Reasons for Refusal of Medical Treatment
Section He-W 501.09 Payment for
Medical Evaluations
Section He-W 501.10 Temporary
Adjustment Period
Section He-W 501.11 Fair
Hearings
Section He-W 501.12 Eligibility
Pending a Decision
PART He-W 502 AID TO THE NEEDY
BLIND PROGRAM
Section He-W 502.01 Definitions
Section He-W 502.02 Recipient
Eligibility
Section He-W 502.03 Blindness
Evaluation
PART He-W 503 AID TO THE
PERMANENTLY AND TOTALLY DISABLED (APTD) PROGRAM
Section He-W 503.01 Definitions
Section He-W 503.02 Recipient
Eligibility
Section He-W 503.03 Disability
Evaluation
Section He-W 503.04 Precedence
of Adverse Social Security Disability Determinations
PART He-W 504 MEDICAID FOR
EMPLOYED ADULTS WITH DISABILITIES
Section He-W 504.01 Definition
Section He-W 504.02 Medical
Eligibility
PART He-W 505 REPEALED & RESERVED
PART He-W 506 MEDICAID CARE MANAGEMENT
(MCM)
Section He-W
506.01 Purpose
Section He-W
506.02 Scope
Section He-W
506.03 Definitions
Section He-W
506.04 Covered Services
Section He-W 506.05 Enrollment in Managed Care
Section He-W 506.06 Selection of a Managed Care Organization
Section He-W
506.07 MCO Grievance Process
Section He-W
506.08 MCO Appeal Process
Section He-W
506.09 Department Fair Hearing Process
PART He-W 507 MEDICAL ASSISTANCE
FOR CHILDREN WITH SEVERE DISABILITIES
Section He-W 507.01 Definitions
Section He-W 507.02 Recipient
Eligibility
Section He-W 507.03 Continued
Eligibility
Section He-W 507.04 Termination
of Medical Eligibility
Section He-W 507.05 Appeals
PART He-W 508 MEDICAL ASSISTANCE
FOR HOME CARE OF CERTAIN CHILDREN WITH SEVERE DISABILITIES
Section He-W
508.01 Purpose
Section He-W
508.02 Definitions
Section He-W
508.03 Recipient Eligibility
Section He-W
508.04 Degree of Care
Section He-W 508.05 Medically Appropriate Services
Section He-W
508.06 Monitoring and Determination of
Cost Effectiveness
Section He-W
508.07 Recipient Notification of Cost
Effectiveness Monitoring and Determination Results
Section He-W
508.08 Cost Reduction Plans
Section He-W
508.09 Continued Medical Eligibility for
HC-CSD
Section He-W
508.10 Denial or Termination of Medical
Eligibility for HC-CSD
PART He-W 509 FAMILY PLANNING EXPANSION CATEGORY (FPEC)
Section He-W 509.01
Purpose
Section He-W 509.02
Definitions
Section He-W 509.03
Eligibility
Section He-W 509.04
Provider Participation
Section He-W 509.05
Service Limits
Section He-W 509.06
Covered Services
Section He-W 509.07
Non-Covered Services
Section He-W 509.08
Transportation
Section He-W 509.09
Co-Payments
Section He-W 509.10
Utilization Review and Control
Section He-W 509.11
Third Party Liability
Section He-W 509.12
Payment for Services
PART He-W 510 RESERVED
PART He-W 511 HEALTH INSURANCE
PREMIUM PAYMENT PROGRAM (HIPP)
Section He-W 511.01 Purpose
Section He-W 511.02 Scope
Section He-W 511.03 Definitions
Section He-W 511.04 Recipient Participation
Section He-W 511.05 Cost Effectiveness Determination
Section He-W 511.06 Cost Effectiveness Redetermination
Section He-W 511.07 Wrap Around Coverage
Section He-W 511.08 Payment of Cost Sharing
Section He-W 511.09 Loss of Eligibility and Discontinuation of
Premium Payments
Section He-W 511.10 Third Party Liability
Section He-W 511.11 Utilization Review & Control
PART He-W 512 RESERVED
PART He-W 513 SUBSTANCE USE
DISORDER (SUD) TREATMENT AND RECOVERY SUPPORT SERVICES
Section He-W 513.01 Purpose
Section He-W 513.02 Definitions
Section He-W 513.03 Recipient Eligibility
Section He-W 513.04 Provider Participation
Section He-W 513.05 Covered Services
Section He-W 513.06 Non-Covered Services
Section He-W 513.07 Utilization Review and Control
Section He-W 513.08 Third Party Liability
Section He-W 513.09 Payment for Services
Section He-W 513.10 Documentation
Section He-W 513.11 ASAM Level of Care Service Descriptions
Section He-W 513.12 Waivers
PARTS He-W 514 THROUGH 518
RESERVED
PART He-W 519 PAYMENTS TO
DISPROPORTIONATE SHARE PSYCHIATRIC HOSPITALS - MOVED TO He-M 601
PART He-W 520 GENERAL PROGRAM
INFORMATION
Section He-W 520.01 Definitions
Section He-W 520.02 Program
Administration
Section He-W 520.03 Record
Keeping Requirements
Section He-W 520.04 Surveillance
and Utilization Review and Control
Section He-W 520.05 Fraud
Detection and Investigation
Section He-W 520.06 Provider
Requirements
PART He-W 521 GENERAL PAYMENT
INFORMATION
Section He-W 521.01 Definitions
Section He-W 521.02 Payment
Rates
Section He-W 521.03 Payment in
Full
Section He-W 521.04 Adjustments
to Payments
Section He-W 521.05 Recipient
Eligibility
Section He-W 521.06 Prior
Authorization
Section He-W 521.07 Third Party
Liability
Section He-W 521.08 Accidental
Injury
Section He-W 521.09 Medicare
Co-insurance and Deductible
Section He-W 521.10 Submission
of Claims and Billing Time Limitation
Section He-W 521.11 Exclusion of
Medicaid Providers Who Have Been Excluded by Medicare
Section He-W 521.12 Exclusion,
Suspension or Termination of Medicaid Providers by Medicaid
PART He-W 522 INTERPRETER
SERVICES
Section He-W 522.01 Definitions
Section He-W 522.02 Covered
Services and Conditions
Section He-W 522.03 Provider
Participation
Section He-W 522.04 Payment to
Family Members Prohibited
Section He-W 522.05 Payment for
Services
PARTS He-W 523 through He-W 528
RESERVED
PART He-W 529 -
RESERVED
PART He-W 530 SERVICE LIMITS, CO-PAYMENTS,
AND NON-COVERED SERVICES
Section He-W 530.01 Definitions
Section He-W 530.02 Recipients
Subject to Service Limits, Co-Payments, and Non-Covered Services
Section He-W 530.03 Service
Limits
Section He-W 530.04 Co-Payments
Section He-W 530.05 Non-Covered
Services
Section He-W 530.06 Recipient
Responsibility for Payment
Section He-W 530.07 Prior Authorization
of Services Which Exceed Service Limits
PART He-W 531 PHYSICIAN SERVICES
Section He-W 531.01 Definitions
Section He-W 531.02 Recipient
Eligibility
Section He-W 531.03 Provider
Participation
Section He-W 531.04 Service
Limits
Section He-W 531.05 Covered
Services
Section He-W 531.06 Non-Covered
Services
Section He-W 531.07 Prior
Authorization
Section He-W 531.08 Utilization
Review and Control
Section He-W 531.09 Third Party
Liability
Section He-W 531.10 Payment for
Services
PART He-W 532 PODIATRY SERVICES
Section He-W 532.01 Definitions
Section He-W 532.02 Recipient
Eligibility
Section He-W 532.03 Provider
Participation
Section He-W 532.04 Service
Limits
Section He-W 532.05 Covered
Services
Section He-W 532.06 Non-Covered
Services
Section He-W 532.07 Documentation
Section He-W 532.08 Utilization
Review and Control
Section He-W 532.09 Third Party
Liability
Section He-W
532.10 Payment for Services
PART He-W 533 RESERVED
PART He-W 534 ADVANCED
REGISTERED NURSE PRACTITIONER SERVICES
Section He-W 534.01 Definitions
Section He-W 534.02 Recipient
Eligibility
Section He-W 534.03 Provider Participation
Section He-W 534.04 Service
Limits
Section He-W 534.05 Covered
Services
Section He-W 534.06 Utilization
Review & Control
Section He-W 534.07 Third Party
Liability
Section He-W 534.08 Payment for
Services
PART He-W 535 PSYCHOLOGIST SERVICES
Section He-W 535.01 Definitions
Section He-W 535.02 Recipient
Eligibility
Section He-W 535.03 Provider
Participation
Section He-W 535.04 Service
Limits
Section He-W 535.05 Covered
Services
Section He-W 535.06 Non-covered
Services
Section He-W 535.07 Utilization
Review and Control
Section He-W 535.08 Third Party
Liability
Section He-W 535.09 Payment for
Services
PART He-W 536 MEDICAL SERVICES
CLINIC
Section He-W 536.01 Definitions
Section He-W 536.02 Recipient
Eligibility
Section He-W 536.03 Provider
Participation
Section He-W 536.04 Service
Limits
Section He-W 536.05 Covered
Services
Section He-W 536.06 Utilization
Review and Control
Section He-W 536.07 Third Party
Liability
Section He-W 536.08 Payment for
Services
PART He-W 537 RURAL HEALTH
CLINICS
Section He-W 537.01 Definitions
Section He-W 537.02 Recipient
Eligibility
Section He-W 537.03 Provider
Participation
Section He-W 537.04 Service
Limits
Section He-W 537.05 Covered
Services
Section He-W 537.06 Utilization
Review and Control
Section He-W 537.07 Third Party
Liability
Section He-W 537.08 Payment for
Services
PART He-W 538 CERTIFIED MIDWIFE
SERVICES
Section He-W 538.01 Definitions
Section He-W 538.02 Recipient
Eligibility
Section He-W 538.03 Provider
Participation
Section He-W 538.04 Covered
Services
Section He-W 538.05 Non-Covered
Services
Section He-W 538.06 Utilization
Review and Control
Section He-W 538.07 Third Party
Liability
Section He-W 538.08 Payment for
Services
PART He-W 539 - RESERVED
PART He-W 540 PRIVATE DUTY
NURSING SERVICES
Section He-W 540.01 Definitions
Section He-W 540.02 Recipient
Eligibility
Section He-W 540.03 Provider
Participation
Section He-W 540.04 Covered
Services
Section He-W 540.05 Non-covered
Services
Section He-W 540.06 Required
Documentation
Section He-W 540.07 Prior
Authorization and Review
Section He-W 540.08 Utilization
Review and Control
Section He-W 540.09 Third Party
Liability
Section He-W 540.10 Payment for
Services
PART He-W 541 FAMILY PLANNING
SERVICES
Section He-W 541.01 Definitions
Section He-W 541.02 Recipient
Eligibility
Section He-W 541.03 Provider
Participation
Section He-W 541.04 Service
Limits
Section He-W 541.05 Covered Services
Section He-W 541.06 Non-Covered
Services
Section He-W 541.07 Co-Payments
Section He-W 541.08 Utilization
Review and Control
Section He-W 541.09 Third Party
Liability
Section He-W 541.10 Payment for
Services
PART He-W 542 ABORTION SERVICES
Section He-W 542.01 Definitions
Section He-W 542.02 Recipient
Eligibility
Section He-W 542.03 Provider
Participation
Section He-W 542.04 Covered
Services
Section He-W 542.05 Non-Covered
Services
Section He-W 542.06 Utilization
Review and Control
Section He-W 542.07 Third Party
Liability
Section He-W 542.08 Payment for
Services
PART He-W 543 HOSPITAL SERVICES
Section He-W 543.01 Definitions
Section He-W 543.02 Recipient
Eligibility
Section He-W 543.03 Provider
Participation
Section He-W 543.04 Prior
Authorization
Section He-W 543.05 Covered
Services
Section He-W 543.06 Non-Covered
Services
Section He-W 543.07 Readmission
to Hospital
Section He-W 543.08 Transfer of
Recipient
Section He-W 543.09
Section He-W 543.10 Medicare Participation
Section He-W 543.11 Utilization
Review
Section He-W 543.12 Third Party
Liability
Section He-W 543.13 Payment for
Services
PART He-W 544 HOSPICE SERVICES
Section He-W 544.01 Definitions
Section He-W 544.02 Recipient
Eligibility Requirements
Section He-W 544.03 Provider
Participation
Section He-W 544.04 Election of
Hospice Care
Section He-W 544.05 Hospice
Election Periods
Section He-W 544.06
Certification of Terminal Illness
Section He-W 544.07 Change in
Designated Hospice Provider
Section He-W 544.08 Revocation
of Hospice Care
Section He-W 544.09 Covered Hospice
Services
Section He-W 544.10
Documentation of Hospice Services
Section He-W 544.11 Utilization
Review and Control
Section He-W 544.12 Third Party
Liability
Section He-W 544.13 Payment for
Hospice Services
Section He-W 544.14 Hospice
Payment Limitations and Adjustments
Section He-W 544.15 Hospice
Payment for Recipients in Nursing Facilities
Section He-W 544.16 Payment for
Physicians’ Services
Section He-W 544.17 Required
Forms
PART 545 RESERVED
PART He-W 546 EARLY AND PERIODIC
SCREENING, DIAGNOSIS AND TREATMENT SERVICES
Section He-W 546.01 Definitions
Section He-W 546.02 Recipient
Eligibility
Section He-W 546.03 Provider
Participation
Section He-W 546.04 Informing
Requirements
Section He-W 546.05 Covered
Services
Section He-W 546.06 Prior
Authorization for Coverage Based on Medical Necessity
Section He-W 546.07 Support
Services
Section He-W 546.08 Non-Covered
Services
Section He-W 546.09 Utilization
Review and Control
Section He-W 546.10 Third Party
Liability
Section He-W 546.11 Payment for
Services
PART He-W 547 HOME VISIT FOR
POSTPARTUM AND NEWBORN ASSESSMENT
Section He-W 547.01 Definitions
Section He-W 547.02 Recipient
Eligibility
Section He-W 547.03 Provider
Participation
Section He-W 547.04 Covered
Services
Section He-W 547.05 Non-Covered
Services
Section He-W 547.06 Required
Documentation
Section He-W 547.07 Utilization
Review and Control
Section He-W 547.08 Third Party
Liability
Section He-W 547.09 Payment for
Services
PART He-W 548 EXTENDED SERVICES
TO PREGNANT WOMEN
Section He-W 548.01 Definitions
Section He-W 548.02 Recipient
Eligibility
Section He-W 548.03 Provider
Participation
Section He-W 548.04 Covered
Services
Section He-W 548.05 Non-Covered
Services
Section He-W 548.06 Required
Documentation
Section He-W 548.07 Utilization
Review and Control
Section He-W 548.08 Third Party
Liability
Section He-W 548.09 Payment for
Services
PART He-W
549 HOME VISITING
Section He-W 549.01 Definitions
Section He-W 549.02 Recipient
Eligibility
Section He-W 549.03 Amount of
Services
Section He-W 549.04 Provider
Participation
Section He-W 549.05 Covered
Services
Section He-W 549.06 Non-Covered
Services
Section He-W 549.07 Required
Documentation
Section He-W 549.08 Utilization
Review and Control
Section He-W 549.09 Third Party
Liability
Section He-W 549.10 Payment for
Services
PART He-W 550 ADULT MEDICAL DAY
CARE SERVICES - EXPIRED (Now He-E 803)
PART He-W 551 RESERVED
PART He-W 552 PERSONAL CARE
ATTENDANT SERVICES
Section He-W 552.01 Purpose
Section He-W 552.02 Definitions
Section He-W 552.03 Recipient
Eligibility
Section He-W 552.04 Provider
Participation
Section He-W 552.05 Covered
Services
Section He-W 552.06 Non-covered
Services
Section He-W 552.07 Training
Requirements
Section He-W 552.08 Provider and
PCA Responsibilities
Section He-W 552.09 Personal
Care Assessments and the Plan of Care
Section He-W 552.10 Utilization
Review and Control
Section He-W 552.11 Third Party
Liability
Section He-W 552.12 Payment for
Services
Section He-W 552.13
Documentation
PART He-W 553 HOME HEALTH
SERVICES
Section He-W 553.01 Purpose
Section He-W 553.02 Definitions
Section He-W 553.03 Recipient
Eligibility
Section He-W 553.04 Provider
Participation
Section He-W 553.05 Required
Documentation
Section He-W 553.06 Covered
Services
Section He-W 553.07 Non-Covered
Services
PART He-W 554 - 555 RESERVED
PART He-W 556 SUPPORTED
RESIDENTIAL HEALTH CARE FACILITY SERVICES
Section He-W 556.01 Definitions
Section He-W 556.02 Recipient
Eligibility
Section He-W 556.03 Provider
Participation
Section He-W 556.04 Covered
Services
Section He-W 556.05 Financial
Assistance
Section He-W 556.06 Prior
Authorization and Review
Section He-W 556.07 Notice of
Approval or Denial
Section He-W 556.08 Payment for
Services and Rate Setting
Section He-W 556.09 Utilization
Review and Control
PART He-W 557 RESERVED
PART He-W 558 HOME AND
COMMUNITY-BASED SERVICES FOR THE ELDERLY AND CHRONICALLY ILL
Section He-W 558.01 Definitions
Section He-W 558.02 Client
Eligibility
Section He-W 558.03 Provider
Participation
Section He-W 558.04 Plan of Care
Section He-W 558.05 Covered
Services
Section He-W 558.06 Initial
Level of Care Determinations
Section He-W 558.07 Utilization
Review
Section He-W 558.08 Right of
Choice
Section He-W 558.09 Payment for
Services
PART He-W 559 CASE MANAGEMENT OF
ADVANCE CARE PLANNING AND DIRECTIVES -EXPIRED
PART He-W 560 - 564 RESERVED
PART He-W 565 VISION CARE
SERVICES
Section He-W 565.01 Definitions
Section He-W 565.02 Recipient
Eligibility
Section He-W 565.03 Provider
Participation
Section He-W 565.04 Service
Limits
Section He-W 565.05 Covered
Services
Section He-W 565.06 Non-Covered
Services
Section He-W 565.07 Utilization
Review and Control
Section He-W 565.08 Third Party
Liability
Section He-W 565.09 Payment for
Services
PART He-W 566 DENTAL SERVICES
Section He-W 566.01 Definitions
Section He-W 566.02 Recipient
Eligibility
Section He-W 566.03 Provider
Participation
Section He-W 566.04 Covered
Services
Section He-W 566.05 Orthodontic
Treatment
Section He-W 566.06 Non-Covered
Services
Section He-W 566.07 Prior
Authorization
Section He-W 566.08 Utilization
Review and Control
Section He-W 566.09 Third Party
Liability
Section He-W 566.10 Payment for
Services
PART He-W 567 HEARING AID
SERVICES
Section He-W 567.01 Definitions
Section He-W 567.02 Recipient
Eligibility
Section He-W 567.03 Provider
Participation
Section He-W 567.04 Service
Limits
Section He-W 567.05 Covered
Services
Section He-W 567.06 Non-Covered
Services
Section He-W 567.07 Prior
Authorization of Binaural Hearing Aids for Recipients 21 Years of Age or Older
Section He-W 567.08
Documentation
Section He-W 567.09 Utilization
Review and Control
Section He-W 567.10 Third Party
Liability
Section He-W 567.11 Payment for
Services
PART He-W 568 PHYSICAL THERAPY,
OCCUPATIONAL THERAPY AND SERVICES FOR INDIVIDUALS WITH SPEECH, HEARING AND
LANGUAGE DISORDERS
Section He-W 568.01 Definitions
Section He-W 568.02 Recipient Eligibility
Section He-W 568.03 Provider Participation
Section He-W 568.04 Service Limits
Section He-W 568.05 Covered Services
Section He-W 568.06 Prior Authorization
Section He-W 568.07 Utilization Review and Control
Section He-W 568.08 Documentation
Section He-W 568.09 Third Party Liability
Section He-W 568.10 Payment for Services
PART He-W 569 RADIOLOGICAL
SERVICES
Section He-W 569.01 Definitions
Section He-W 569.02 Recipient
Eligibility
Section He-W 569.03 Provider
Participation
Section He-W 569.04 Service
Limits
Section He-W 569.05 Covered
Services
Section He-W 569.06 Prior
Authorization and Review
Section He-W 569.07 Utilization Review
and Control
Section He-W 569.08 Third Party
Liability
Section He-W 569.09 Payment for
Services
PART He-W 570 PHARMACEUTICAL
SERVICES
Section He-W 570.01 Definitions
Section He-W 570.02 Recipient
Eligibility
Section He-W 570.03 Provider
Participation
Section He-W 570.04 Covered
Items
Section He-W 570.05 Non-Covered Items
Section He-W 570.06 Prior
Authorization
Section He-W 570.07 Pharmacy
Lock-In Program
Section He-W 570.08 Prescription
Drug Dispensing Limitations
Section He-W 570.09 Certification
of Prescriptions
Section He-W 570.10
Documentation and Retention
Section He-W 570.11 Utilization
Review and Control
Section He-W 570.12 Third Party
Liability
Section He-W 570.13 Prescription
Co-payment
Section He-W 570.14 Payment for
Drugs
PART He-W 571 DURABLE MEDICAL
EQUIPMENT, PROSTHETIC AND ORTHOTIC DEVICES, AND MEDICAL SUPPLIES
Section He-W 571.01 Definitions
Section He-W 571.02 Recipient
Eligibility
Section He-W 571.03 Dispensing
Provider Participation
Section He-W 571.04 Covered Services
Section He-W 571.05 Prescription,
LMN, and Prior Authorization Requirements
Section He-W 571.06 Non-Covered
Services
Section He-W 571.07 Requirements
for Maintaining Documentation
Section He-W 571.08 Third Party
Liability
Section He-W 571.09 Utilization
Review and Control
Section He-W 571.10 Payment for
Items
PART He-W 572 AMBULANCE SERVICES
Section He-W 572.01 Definitions
Section He-W 572.02 Recipient
Eligibility
Section He-W 572.03 Provider
Participation
Section He-W 572.04 Covered Services
Section He-W 572.05 Non-Covered
Services
Section He-W 572.06 Authorization
Requirements for Scheduled and Routine Ambulance Transportation
Section He-W 572.07 Documentation
Section He-W 572.08 Utilization
Review and Control
Section He-W 572.09 Third Party
Liability
Section He-W 572.10 Payment for
Services
PART He-W 573 WHEELCHAIR VAN
SERVICES
Section He-W 573.01 Definitions
Section He-W 573.02 Recipient
Eligibility
Section He-W 573.03 Provider
Participation
Section He-W 573.04 Service Limits
Section He-W 573.05 Covered
Services
Section He-W 573.06 Non-Covered
Services
Section He-W 573.07 Provider
Requirements
Section He-W 573.08 Documentation
Section He-W 573.09 Safety
Requirements
Section He-W 573.10 Service
Limit Override and Review
Section He-W 573.11 Utilization
Review and Control
Section He-W 573.12 Third Party
Liability
Section He-W 573.13 Payment for
Services
PART He-W 574 GENERAL MEDICAL
TRANSPORTATION
Section He-W 574.01 Definitions
Section He-W 574.02 Recipient
Eligibility
Section He-W 574.03 Provider
Participation
Section He-W 574.04 Limitations
on Covered Services
Section He-W 574.05 Non-Covered
Services
Section He-W 574.06 Submission
of Claims
Section He-W 574.07 Payment for
Services
Section He-W 574.08 Advanced
Authorization
Section He-W 574.09 Extenuating
Circumstances
Section He-W 574.10 Provider
Enrollment System
Section He-W 574.11 Hearings
Section He-W 574.12 Third Party
Liability
Section He-W 574.13 Utilization
Review and Control
PART He-W 575 AUGMENTATIVE AND
ALTERNATIVE COMMUNICATION AID SERVICES
Section He-W
575.01 Definitions
Section He-W 575.02 Recipient Eligibility
Section He-W
575.03 Provider Participation
Section He-W
575.04 Covered Services
Section He-W
575.05 Non-Covered Services
Section He-W
575.06 Prior Authorization
Section He-W
575.07 AAC Evaluation
Section He-W
575.08 Documentation
Section He-W
575.09 Third Party Liability
Section He-W
575.10 Utilization Review and Control
Section He-W
575.11 Payment for AAC Aids
PART He-W 576 MANAGED CARE
ORGANIZATIONS- EXPIRED
PART He-W 577 LABORATORY SERVICES
Section He-W 577.01 Definitions
Section He-W 577.02 Recipient
Eligibility
Section He-W 577.03 Provider
Participation
Section He-W 577.04 Covered
Services
Section He-W 577.05 Utilization
Review and Control
Section He-W 577.06 Third Party
Liability
Section He-W 577.07 Payment for
Services
PART He-W 578 through He-W 588
RESERVED
PART He-W 589 MEDICAL ASSISTANCE
SERVICES PROVIDED BY EDUCATION AGENCIES
Section He-W 589.01 Purpose
Section He-W 589.02 Definitions
Section He-W 589.03 Student Eligibility
Section He-W 589.04 Covered Services and Provider Qualifications
Section He-W 589.05 Non-Covered Services
Section He-W 589.06 Documentation and Payment for Services
Section He-W 589.07 Utilization Review and Control
Section He-W 589.08 Documentation of Expenditure of Non-Federal
Funds
Section He-W 589.09 Waivers
PART He-W 590 NURSING FACILITY
SERVICES
Section He-W 590.01 Definitions
- EXPIRED & REPEALED
Section He-W 590.02 Recipient
Eligibility
Section He-W 590.03 Services in
an Atypical Unit
Section He-W 590.04 Nursing
Facility Care in Swing Bed Hospitals
Section He-W 590.05 Change in
Period of Authorization
Section He-W 590.06 Provider
Participation
Section He-W 590.07 Relocations
of Recipient
Section He-W 590.08 Covered Services
Section He-W 590.09 OMS
Utilization Review
Section He-W 590.10 OMS
Utilization Control and On-Site Inspection
Section He-W 590.11
Certification and Recertification
Section He-W 590.12 Plan of Care
Section He-W 590.13 Denials and
Appeals of OMS Decisions
Section He-W 590.14 Recipient
Personal Accounts
Section He-W 590.15 Absence from
the Facility - REPEALED
Section He-W 590.16 Resident
Assessment System - REPEALED
PART He-W 591 NURSING FACILITY
ENFORCEMENT REMEDIES
Section He-W 591.01 Definitions
Section He-W 591.02 Surveys and
Notification of Non-compliance
Section He-W 591.03 Enforcement
of Remedies
Section He-W 591.04 Timeframes
for Notification of Remedies
Section He-W 591.05 Temporary
Management
Section He-W 591.06 Civil Money
Penalties; Notice and Hearing Requests
Section He-W 591.07 Collection
of Civil Money Penalties
Section He-W 591.08 Disbursement
of Civil Money Penalties
Section He-W 591.09 Duration of
Remedies
Section He-W 591.10
Documentation of Substantial Compliance
Section He-W 591.11 Hearings
Section He-W 591.12 Timeframes
for Requesting Hearings
Section He-W 591.13 Relocation
Procedures
Section He-W 591.14 HCFA/State
Disagreements
PART He-W 592 NURSING ASSISTANT
TRAINING REIMBURSEMENT
Section He-W 592.01 Definitions
Section He-W 592.02
Requirements, Conditions and Limitations - REPEALED
Section He-W 592.03 Payment to
CAN - REPEALED
PART He-W 593 NURSING FACILITY
REIMBURSEMENT - EXPIRED (Moved to He-E 806)
PART He-W 594 through 599
RESERVED
TABLE OF CONTENTS
CHAPTER
He-W 600 FINANCIAL ASSISTANCE AND
ELIGIBILITY FOR MEDICAL CARE
PART He-W 601 DEFINITIONS
Section He-W 601.01 Definitions A
Section He-W 601.02 Definitions B-C
Section He-W 601.03 Definitions D-E
Section He-W 601.04 Definitions F-H
Section He-W 601.05 Definitions I-N
Section He-W 601.06 Definitions O-Q
Section He-W 601.07 Definitions R-S
Section He-W 601.08 Definitions T-V
PART
He-W 602
Program Coverages and Limitations
Section He-W 602.01 General Applicability of Rules in This Chapter
Section He-W 602.02 Applicability of Federal Statutes and
Regulations
Section He-W 602.03 Telephone Application
Section He-W 602.04 Categorically Needy and Medically Needy
Medical Assistance
Section He-W 602.05
60-Month Lifetime Limit on Financial Assistance
Section He-W 602.06
Section He-W 602.07
RESERVED
Section He-W 602.08
Criteria for Extensions to the 60-Month Lifetime Limit
Section He-W 602.09
Duration of Extensions to the 60-Month Time Limit
Section He-W 602.10
Required Verification
Section He-W 602.11
RESERVED
Section He-W 602.12
RESERVED
Section He-W 602.13
RESERVED
Section He-W 602.14
Required Participation in the NHEP Work Program for Families Granted an
Extension of FANF Financial Assistance
Section He-W 602.15 Extension Review Process
Section He-W 602.16 Eligibility for Additional Hardship
Extensions
Section He-W 602.17 Two-Parent Families
PART
He-W 603
INDIVIDUAL RIGHTS AND RESPONSIBILITIES
Section He-W 603.01 Authorized Representative
Section He-W 603.02 Individual Responsibility to Supply Accurate
Information
Section He-W 603.03 Individual Responsibility to Report Changes
PART
He-W 604
Case Decisions
Section He-W 604.01 Case Decisions
Section He-W 604.02 Notice of Decision
Section He-W 604.03 Advance Notice Period
Section He-W 604.04 Electronic Notification
Section He-W 604.05 Electronic Account Access
PART He-W 605
RESERVED
PART
He-W 606
Verification
Section He-W 606.01
General Verification Requirements - All Categories of Financial and
Medical Assistance and Low-Income Subsidy Assistance
Section He-W 606.02 Citizenship/Non-citizen Status
Section He-W 606.03-606.09 Reserved
Section He-W 606.10 Residency
Section He-W 606.11 Temporary Absence from N.H.
Section He-W
606.12-606.17 Reserved
Section He-W 606.18 Institutional Residence
Section He-W 606.19 Presence of a Dependent Child
Section He-W 606.20 Deprivation Due to Death
Section He-W 606.21 Deprivation Due to Continued Absence
Section He-W 606.22 Verification of Unemployment Status for the
Unemployed Parent
(UP) Medical Assistance
Program
Section He-W 606.23 Living with a Specified Relative
Section He-W 606.24 Age
Section He-W 606.25 Reserved
Section He-W 606.26 Strikers
Section He-W 606.27 Reserved
Section He-W 606.28 Proof of Identity
Section He-W 606.29 Reserved
Section He-W 606.30 NHEP Exemption
Section He-W 606.31 Good Cause Reasons for Non-Cooperation with
Child Support Requirement Due to Domestic Violence
Section He-W 606.32 NHEP Medical Exemption Review Process
Section He-W 606.33-606.35 RESERVED
Section He-W 606.36 Social Security Numbers (SSN) – FANF Financial
Assistance
Section He-W 606.37 Application for Disability Benefits
Section He-W
606.38-606.40 Reserved
Section He-W 606.41 Special Medical Assistance Only Coverage
Groups
Section He-W 606.42 OAA Age Requirements
Section He-W
606.43-606.54 Reserved
Section He-W 606.55 Deemed Income
Section He-W
606.56-606.57 Reserved
Section He-W 606.58 Lump Sum Income
Section He-W 606.59 Treatment of Specific Types of Income
Section He-W 606.60 Verification of Educational Income - Adult
Categories
Section He-W 606.61 Educational Expenses - Adult Categories
Section He-W 606.62-606.64 Reserved
Section He-W 606.65 PASS Income and Resources
Section He-W
606.66-606.67 Reserved
Section He-W 606.68 Adult OAA and ANB Employment Expense
Disregard
Section He-W 606.69 Impairment Related Work Expenses
Section He-W
606.70-606.72 Reserved
Section He-W 606.73 Child Care Costs for
All Categories
Section He-W 606.74 Allowable Deductions
Section He-W 606.75 Allocated Income
Section He-W 606.76 Resources - Basic Principles
Section He-W 606.77 Reserved
Section He-W 606.78 Personal Property Resources
Section He-W
606.79-606.82 Reserved
Section He-W 606.83 Verification of Shelter and Living
Arrangement
Section He-W 606.84 Adult Category Verification of Shelter and Living
Arrangement
Section He-W
606.85-606.88 Reserved
Section He-W 606.89 RESERVED
Section He-W 606.90 Retroactive Medical Assistance
Section He-W 606.91 Reserved
Section He-W 606.92 Telephone Determination
Section He-W
606.93-606.97 RESERVED
Section He-W 606.98 Twelve Month Extended Medical Assistance
Section He-W 606.99 Reserved
Section He-W 606.100 Redetermination of Eligibility
Section He-W 606.101-606.103 RESERVED
Section He-W 606.104 Verification Requirements for Emergency
Assistance
PART He-W 607
RESERVED
PART
He-W 608
Use of Money Payments
Section He-W 608.01 Use of Money Payments
Section He-W 608.02 Prohibited Use of Money Payments
PART He-W 609 - 615
RESERVED
PART
He-W 616
Citizenship/Alien Status
Section He-W 616.01 Sponsored Aliens Who Apply for NHEP/FAP
Financial and Medical Assistance
Section He-W 616.02 Eligibility of Qualified Aliens
PART He-W 617
RESERVED
PART
He-W 618
Residency
Section He-W 618.01 RESERVED
Section He-W 618.02 Temporary Absence from N.H.
PART He-W 619 PRESUMPTIVE
ELIGIBILITY FOR HOME AND COMMUNITY-BASED CARE FOR THE ELDERLY AND CHRONICALLY
Section He-W 619.01
Definitions
Section He-W 619.02
Presumptive Eligibility for HCBC-ECI
Section
He-W 619.03 Qualified Providers
Section He-W 619.04 Presumptive Eligibility Determination Process
Section
He-W 619.05 Termination of Presumptive
Eligibility Period
PART He-W
620 aSSET Transfers
Section He-W 620.01 Asset Transfers
PART He-W 621 RESERVED
– (Moved to He-W 821)
PART
He-W 622
Liability of Relatives to Support
Section He-W 622.01 Liability of Relatives to Support
PART He-W 623
RESERVED
PART
He-W 624
Institutional Residence
Section He-W 624.01 Institutional Residence
PART
He-W 625
Technical Requirements for AFDC, OAA, APTD and ANB
Section He-W 625.01 Application for Social Security Account
Numbers
PART He-W 626
TECHNICAL REQUIREMENTS FOR THE FAMILY PLANNING EXPANSION CATEGORY (FPEC)
OF MEDICAL ASSISTANCE
Section He-W 626.01
Purpose
Section He-W 626.02
Family Planning Expansion Category (FPEC)
Section He-W 626.03
Presumptive Eligibility Determination
PART He-W 627 TECHNICAL
REQUIREMENTS FOR IDP AND FWOC CATEGORIES OF FINANCIAL AND MEDICAL ASSISTANCE
Section He-W 627.01
Technical Requirements for the Interim Disabled Parent (IDP) Category of
Financial Assistance
Section He-W 627.02
RESERVED
Section He-W 627.03
Technical Requirements for Families with Older Children (FWOC) Category
of Financial and Medical Assistance
Section He-W 627.04
General Requirements for IDP and FWOC Financial Assistance
Section He-W 627.05
RESERVED
PART He-W 628
DEPRIVATION OF PARENTAL SUPPORT OR CARE FOR FANF FINANCIAL ASSISTANCE
Section He-W 628.01 Deprivation Due to Continued Absence
Section He-W 628.02 Deprivation Due to Incapacity
Section He-W 628.03 Unemployed Parent (UP) Medical Assistance
Program
PART He-W 629 RESERVED
PART
He-W 630
Living with a Specified Relative
Section He-W 630.01 Living with a Specified Relative
PART
He-W 631 UNWED
MINOR PARENTS
Section He-W 631.01 Unwed Minor Parent Requirements
PART
He-W 632
Age
Section He-W 632.01 NHEP/FAP Age Requirements
PART He-W 633 RESERVED
PART
He-W 634
Strikers
Section He-W 634.01 Strikers and Eligibility for NHEP/FAP
Financial Assistance
PART He-W 635 RESERVED
PART He-W 636
TECHNICAL REQUIREMENTS FOR NHEP/FAP FINANCIAL AND MEDICAL ASSISTANCE
Section He-W 636.01 Personal Interview
Section He-W 636.02 Verification of Identity
Section He-W 636.03 School Attendance
Section He-W 636.04-636.07 RESERVED
Section He-W 636.08 Disclosure of Paternity Information
Section He-W 636.09 Good Cause for Failure to Cooperate
Section He-W 636.10 Sanction for Failure to Cooperate
PART He-W 637 THE
Section He-W 637.01 Definitions
Section He-W 637.02 NHEP Orientation
Section He-W 637.03 NHEP Employment Activities Participation
Requirements
Section He-W 637.04 Exemptions
Section He-W 637.05 Compliance
Section He-W 637.06 Failure to Participate/Comply
Section He-W 637.07 Good Cause
Section He-W 637.08 Sanctions
Section He-W 637.09 Initial Assessment
Section He-W 637.10 RESERVED
Section He-W 637.11 RESERVED
Section He-W 637.12 Employability Plan
Section He-W 637.13 Applicability of Existing Employability Plans
Section He-W 637.14 RESERVED
Section He-W 637.15 Single Course Authorization
Section He-W 637.16 RESERVED
Section He-W 637.17 High School Diploma or Equivalent
Section He-W 637.18 Interim Activities
Section He-W 637.19 RESERVED
Section He-W 637.20 On-the-Job-Training (OJT)
Section He-W 637.21 Work Experience and Community Service Program
(WECSP)
Section He-W 637.22 Vocational Educational Training
Section He-W 637.23 Post Secondary Education
Section He-W 637.24 RESERVED
Section He-W 637.25 RESERVED
Section He-W 637.26 RESERVED
Section He-W 637.27 RESERVED
Section He-W 637.28 RESERVED
PART He-W 638 HOMECARE WORKS
Section He-W 638.01 Purpose
Section He-W 638.02 HomeCare Works Program
PART He-W 639 GRANITE WORKFORCE
Section He-W 639.01
Purpose
Section He-W 639.02 Subject
to Available Funding
Section He-W 639.03
Definitions
Section He-W 639.04
Participant Eligibility
Section He-W 639.05
Initial Assessment
Section He-W 639.06
Activities and Services
Section He-W 639.07 Employment
Support Services
Section He-W 639.08
Employer Subsidies
Section He-W 639.09
Termination of GWPP
PART He-W 640 RESERVED
PART
He-W 641
Special Medical Assistance Only Coverage Groups
Section He-W 641.01 Children Up to 20 Years of Age
Section He-W 641.02 Qualified Pregnant Women/60 Day Extended MA
Section He-W 641.03 Medicaid for Employed Adults with
Disabilities (MEAD)
Section He-W 641.04 Severely Disabled Children
Section He-W 641.05 Presumptive Eligibility Determinations
Section He-W 641.06 Medical Coverage for Pregnant Women
Section He-W 641.07 Medical Coverage for Low Income Children under
Healthy-Kids Gold
Section He-W 641.08 RESERVED
Section He-W 641.09 Breast and Cervical Cancer Program
PART
He-W 642
Categorical Requirements - Adult Financial and Medical Assistance
Section He-W 642.01 Reserved
Section He-W 642.02 OAA Categorical Requirements
Section He-W 642.03 APTD Categorical Requirements
Section He-W 642.04 ANB Categorical Requirements
PART He-W 643
RESERVED
PART
He-W 644
Technical Requirements for Adult Financial and Medical Assistance
Section He-W 644.01 Personal Interview
PART He-W 645 - 647
RESERVED
PART
He-W 648
Residential Care Facilities and Community Residences
Section He-W 648.01 Reserved
Section He-W 648.02 Residential Care Facilities
Section He-W 648.03 Community Residences
PART He-W 649 - 651
RESERVED
PART
He-W 652
Income - Basic Principles
Section He-W 652.01 Reserved
Section He-W 652.02 Availability of Funds
Section He-W 652.03 Deemed Income For Financial Assistance
Section He-W 652.04 Reserved
Section He-W 652.05 Conversion to Monthly Amounts
Section He-W 652.06 Fluctuating Income
Section He-W 652.07 Developing Potential Sources of Income
PART He-W 653
RESERVED
PART
He-W 654
Evaluation and Treatment of Income
Section He-W 654.01 Evaluation and Treatment of Income
Section He-W 654.02 Income Computation
Section He-W 654.03 Lump Sum Income - NHEP/FAP Financial
Assistance
Section He-W 654.04 Treatment of Specific Types of Income
Section He-W 654.05 Educational Income - Adult Categories
Section He-W 654.06 Educational Expenses - Adult Categories
Section He-W 654.07 Income-In-Kind
Section He-W 654.08 Provided Shelter
Section He-W 654.09 Treatment of Assigned Support
Section He-W 654.10 Deemed Income from a Non-citizen’s Sponsor
Section He-W 654.11 Federally Mandated Excluded Income
Section He-W 654.12 Other Excluded Income
Section He-W 654.13 Earned Income Disregard (EID) and Employment
Expense Disregard (EED) for Financial Assistance to Needy Families (FANF)
Section He-W 654.14 Child/Dependent Care Disregard
Section He-W 654.15 Adult Category Earned Income Disregard
Section He-W 654.16 Adult Standard Disregard
Section He-W 654.17 Post-Eligibility Computation of Cost of Care
for Nursing Facility Care
Section He-W 654.18 Adult Employment Expense Disregard
Section He-W 654.19 Child Care Costs
Section He-W 654.20 Allowable Deductions
Section He-W 654.21 Allocated Income
PART
He-W 655
Purchased Services for Employment Support Services
Section He-W 655.01 Definitions
Section He-W 655.02 Availability of Funds
Section He-W 655.03 Eligibility for Child Care
Section He-W 655.04 Methods of Payment
Section He-W 655.05 Fees and Supplies
Section He-W 655.06 Transportation Assistance
Section He-W 655.07 Tuition Assistance
PART
He-W 656 Resources
Section He-W 656.01 Resources - Basic Principles
Section He-W 656.02 Treatment of Specific Types of Resources
Section He-W 656.03 Jointly Owned Resources
Section He-W 656.04 Personal Property Resources
Section He-W 656.05 Real Property Resources
Section He-W 656.06 Resource Limits
PART He-W 657
RESERVED
PART
He-W 658
Standard of Need
Section He-W 658.01 Financial Assistance to Needy Families (FANF)
Standard of Need
Section He-W 658.02 Financial Assistance to Needy Families
Payment Standard
Section He-W 658.03 Adult Category Standard of Need
Section He-W 658.04 RESERVED
Section He-W 658.05 RESERVED
Section He-W 658.06 RESERVED
Section He-W 658.07
REPEALED
PART He-W 659 - 661 RESERVED
PART He-W
662 RESERVED
PART He-W 663 RESERVED
PART He-W 664
SEPARATE MEDICAL ASSISTANCE GROUP
Section He-W 664.01 RESERVED
Section He-W 664.02 FANF Medical Assistance Only Case – MOVED TO He-W 864.02
PART He-W 665 - 669
RESERVED
PART
He-W 670
Determination of Financial Eligibility and the Amount of Assistance
Section He-W
670.01-670.02 Reserved
Section He-W 670.03 Determination of the Grant
Section He-W 670.04 Determination of the Assistance Payment
PART He-W 671
ISSUANCE OF ASSISTANCE PAYMENTS
Section He-W 671.01 Electronic Benefit Transfer (EBT)
Section He-W 671.02 Electronic Funds Transfer (EFT)
Section He-W 671.03 Adjustment to an Electronic Benefit Transfer
(EBT) Account
Section He-W 671.04 Paper Checks
PART
He-W 672
Initiation of Financial Assistance
Section He-W 672.01 Initiation of Financial Assistance to Needy
Families (FANF) Category Financial Assistance
Section He-W 672.02 Initiation of Adult Category Financial
Assistance
PART He-W 673
RESERVED
PART He-W
674 Termination of Financial Assistance
Section He-W 674.01 Termination of Financial Assistance
PART He-W 675 RESERVED
PART He-W
676 RESERVED
PART He-W 677
RESERVED
PART
He-W 678 RESERVED
PART He-W 679
RESERVED
PART
He-W 680
Initiation of Medical Assistance – Moved to He-W
880
PART He-W 681
RESERVED
PART
He-W 682
Termination of Medical Assistance
Section He-W 682.01-682.05 RESERVED
PART He-W 683
RESERVED
PART
He-W 684
Redetermination of Eligibility
Section He-W 684.01 Redeterminations - General
Section He-W 684.02 Regularly Scheduled Redeterminations
PART
He-W 685
Additional Eligibility Requirements
Section He-W 685.01 Special Reviews of Eligibility
PART
He-W 686
PROTECTIVE AND VENDOR PAYMENTS
Section He-W 686.01 Protective and Vendor Payments
PART He-W
687 RESERVED
PART
He-W 688
Corrective Payments
Section He-W 688.01 Corrective Payments
PART He-W
689 RESERVED
PART
He-W 690
Reimbursement
Section He-W 690.01 Reimbursement
PART He-W 691 RESERVED
PART
He-W 692
Recoupment
Section He-W 692.01 Reserved
Section He-W 692.02 Erroneously Paid Financial Assistance
Section He-W 692.03 Erroneously Paid Medical Assistance
PART
He-W 693 FANF
INTENTIONAL PROGRAM VIOLATIONS
Section He-W 693.01 Applicability
Section He-W 693.02 Intentional Program Violation
Section He-W 693.03 Administrative Disqualification Hearing
Procedures
Section He-W 693.04 Waiver of the Administrative Disqualification
Hearing
Section He-W 693.05 Court Actions on Consent Agreements
Section He-W 693.06 Disqualification Penalties
PART
He-W 694
Funeral and Burial Expenses
Section He-W 694.01 Funeral and Burial Expenses
PART
He-W 695 - RESERVED
PART
He-W 696 NUTRITIONAL
SUPPLEMENT FOR WORKING FAMILIES (NSWF)
Section He-W 696.01
Purpose
Section He-W 696.02
Nutritional Supplement for Working Families (NSWF)
PART
He-W 697
RESERVED
PART
He-W 698 Buy In of Medicare Part B
Section He-W 698.01 Buy-In of Medicare Part B
PART
He-W 699
Special Payment Situations
Section He-W 699.01 Reserved
Section He-W 699.02 Post Office Boxes and General Delivery
Mailing Addresses
Section He-W 699.03 RESERVED
Section He-W 699.04 Deceased Recipients
Section He-W 699.05 Emergency Assistance
Section He-W 699.06 Special Needs Payments for OAA, ANB, and APTD
Financial Assistance Recipients
TABLE OF CONTENTS
CHAPTER
He-W 700 FOOD STAMPS
PART He-W 701 DEFINITIONS
Section He-W 701.01 Able Bodied Adult Without Dependents (ABAWD)
Section He-W 701.02 RESERVED
Section He-W 701.03 Educational Income
Section He-W 701.04 Electronic Benefit Transfer (EBT)
Section He-W 701.05 Food Stamp Account
Section
He-W 701.06 Personal Identification
Number (PIN)
Section He-W 701.07 Questionable
Section He-W 701.08 EXPIRED
Section He-W 701.09 EXPIRED
Section He-W 701.10 Verification
PART He-W 702 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM
(SNAP) BENEFIT ISSUANCE
Section He-W 702.01 Method of Issuance
Section He-W 702.02 RESERVED
Section He-W 702.03 Telephone Application
PART He-W 703 RESERVED
PART He-W 704 CASE DECISIONS
Section He-W 704.01-704.03 RESERVED
Section He-W 704.04 Electronic Notification
Section
He-W 704.05 Electronic Account Access
PARTS He-W 705 through He-W 707 -
RESERVED
PART He-W 708 CLAIMS AGAINST HOUSEHOLDS
Section He-W 708.01 Collection Action on Claims
PART He-W 709 ADMINISTRATIVE DISQUALIFICATION HEARINGS ON
INTENTIONAL PROGRAM VIOLATION
Section He-W 709.01 RESERVED
Section He-W 709.02 Waived Hearings
Section He-W 709.03 Timeframe for Signing Waivers
PARTS He-W 710 through He-W 721 -
RESERVED
PART He-W 722 INTERVIEWING HOUSEHOLDS
Section He-W 722.01 Interview Requirements
PART He-W 723 - RESERVED
PART He-W 724 VERIFICATION REQUIREMENTS
Section He-W 724.01 Required Verification
PARTS He-W 725 through He-W 731 - RESERVED
PART He-W 732 SOCIAL SECURITY ENUMERATION
Section He-W 732.01 Social Security Enumeration Requirements
PART He-W 733 - RESERVED
PART He-W 734 DISQUALIFICATIONS
Section He-W 734.01 Disqualifications for Voluntary Quit
Section He-W 734.02 RESERVED
Section He-W 734.03 Child Support
Section He-W 734.04 Work Requirements
PARTS He-W 735 through He-W 739 - RESERVED
PART He-W 740 INCOME
Section He-W 740.01 Excluded Income
PART He-W 741 RESOURCES
Section He-W 741.01 Excluded Resources
PART He-W 742 ALLOWABLE INCOME DEDUCTIONS
Section He-W 742.01 Mileage for Medical Travel
Section He-W 742.02 Utility Expenses Incurred Separately
PART He-W 743 - RESERVED
PART He-W 744 DETERMINATION OF MONTHLY FOOD STAMP INCOME AND
DEDUCTIONS AND HOUSEHOLD ELIGIBILITY
Section He-W 744.01 Averaging Income
Section He-W 744.02 Ineligible Alien Income and Financial
Resources
Section He-W 744.03 Fluctuating Income
PART He-W 745 - RESERVED
PART He-W 746 ACTIONS ON ELIGIBLE HOUSEHOLDS
Section He-W 746.01 Determination of the Monthly Allotment
Section He-W 746.02 Establishing Certification Periods
Section He-W 746.03 Withdrawal of Fair Hearing Requests
PART He-W 747 - RESERVED
PART He-W 748 EMPLOYMENT AND TRAINING REQUIREMENTS
Section He-W 748.01 Reimbursement for Mileage
Section He-W 748.02 RESERVED
Section He-W 748.03 RESERVED
PART He-W 749 - RESERVED
PART He-W 750 ACTIONS BECAUSE OF DELAYED ELIGIBILITY
DETERMINATIONS
Section He-W 750.01 Actions Because of Delayed Eligibility Determinations
PART He-W 751 REPORTING REQUIREMENTS
Section He-W 751.01 Change
Reporting Requirements
PART He-W 752 NOTICES TO CLIENTS
Section He-W 752.01 Change Report Form
PARTS He-W 753 through He-W 755 - RESERVED
PART He-W 756 DETERMINATION OF ELIGIBILITY FOR SPECIAL
SITUATION HOUSEHOLDS
Section He-W 756.01 Households with Shared Custody of Children
Section He-W 756.02 Households Receiving or Paying Child Support
Section He-W 756.03 Households in Community Residences
Section He-W 756.04 Self-employment
Section He-W 756.05 Adopted Children Age
18 up to Age 22 Residing with a Birthparent Who Has Relinquished Parental
Rights
Section He-W 756.06 Public Assistance Households
Section He-W 756.07 Households with an Individual Development
Account
PART He-W 757 - RESERVED
PART He-W 758 TARGET POPULATION - ELDERLY AND DISABLED INDIVIDUALS
Section He-W 758.01 Medical Expenses of Target Population Members
PARTS He-W 759 through He-W 765 -
RESERVED
PART He-W 766 RECERTIFICATION OF ELIGIBILITY
Section He-W 766.01 Recertification of Eligibility
Section He-W 766.02 Telephone Redetermination
PARTS He-W 767 through He-W 774 -
RESERVED
PART He-W 775 - PROGRAM OPTIONS - RESERVED
TABLE OF CONTENTS
CHAPTER
He-W 800 ELIGIBILITY FOR MEDICAL ASSISTANCE
PART
He-W 802 PROGRAM COVERAGES AND
LIMITATIONS
Section
He-W 802.03 Telephone Application
PART
He-W 803 INDIVIDUAL RIGHTS AND RESPONSIBILITIES
Section
He-W 803.01 Authorized Representative
Section
He-W 803.02 Individual Responsibility to
Supply Accurate Information
Section
He-W 803.03 Individual Responsibility to
Report Changes
PART
He-W 804 CASE DECISIONS
Section
He-W 804.01-804.03 RESERVED
Section
He-W 804.04 Electronic Notification
Section
He-W 804.05 Electronic Account Access
PART He-W 805
RESERVED
PART
He-W 806 VERIFICATION
Section
He-W 806.01-806.36 RESERVED
Section
He-W 806.18 Institutional Residence
Section
He-W 806.37 Applications for Disability
Benefits
Section
He-W 806.38 806.59 RESERVED
Section
He-W 806.55 Deemed Income
Section He-W 806.60 Verification of Educational Income – Adult
Categories
Section He-W 806.61 806.67
RESERVED
Section
He-W 806.68 Adult OAA, APTD, and ANB
Employment Expense Disregard
Section
He-W 806.69 Impairment Related Work
Expenses
Section
He-W 806.70 806.73 RESERVED
Section He-W 806.74 Allowable Deductions
Section
He-W 806.75-806.77 RESERVED
Section
He-W 806.78 Personal Property Resources
Section
He-W 806.79 806.88 RESERVED
Section He-W 806.89 Verification Requirements for In and Out
Medically Needy Medical Assistance
Section He-W 806.90
806.91 RESERVED
Section He-W 806.92 Telephone Redetermination
PARTS He-W 807 through He-W 815 RESERVED
PART He-W 816 Citizenship/Alien Status
Section He-W 816.02 Eligibility of Qualified Aliens
PARTS He-W 817 through He-W 819 RESERVED
PART
He-W 820 ASSET TRANSFERS
Section He-W 820.01 Purpose
Section He-W 820.02 Definitions
Section He-W 820.03 Asset Transfers
PART He-W 821 TECHNICAL REQUIREMENTS FOR NURSING FACILITY (NF)
AND HOME AND COMMUNITY BASED CARE (HCBC) SERVICES
Section He-W 821.01 Asset Transfer Penalty Undue Hardship Waiver
Section He-W 821.02 Hardship Waiver for Individuals with Substantial
Home Equity
Section He-W 821.03 Administrative Appeals
PARTS
He-W 822 through He-W 823 RESERVED
PART
He-W 824 INSTITUTIONAL RESIDENCE
Section
He-W 824.01 Institutional Residence
PARTS He-W 825 through He-W 836 RESERVED
PART
He-W 837 GRANITE ADVANTAGE HEALTH CARE PROGRAM
Section
He-W 837.01 Definitions
Section
He-W 837.02 Community Engagement
Requirement
Section
He-W 837.03 Exemptions
Section
He-W 837.04 Request for Exemption;
Duration of Exemptions
Section
He-W 837.05 Qualifying Activities
Section
He-W 837.06 Reporting of Community Engagement
Activities and Crediting of Hours
Section
He-W 837.07 Beneficiaries with
Disabilities: Reasonable Modification
Section
He-W 837.08 Opportunity to Cure
Section
He-W 837.09 Suspension
Section
He-W 837.10 Good Cause
Section
He-W 837.11 Crediting a Finding of Good
Cause
Section
He-W 837.12 Limitation on the Repeated
Consecutive Use of Curing to Meet the Community Engagement Requirement
Section
He-W 837.13 Extra Hours
Section
He-W 837.14 Disenrollment and
Reconsideration
Section
He-W 837.15 Re-Application
Section
He-W 837.16 Screening for Other Bases of
Medicaid Eligibility Prior to Suspension, Termination, Disenrollment or Denial
of Eligibility
Section
He-W 837.17 Appeals
Section
He-W 837.18 Other Department Obligations
PARTS He-W 838 through 840 RESERVED
PART He-W 841
Section He-W 841.01 RESERVED
Section He-W 841.02 RESERVED
Section He-W 841.03 Medicaid for Employed Adults with Disabilities
(MEAD)
PARTS He-W 842 through 843 RESERVED
PART
He-W 844 Technical Requirements for Adult Medical Assistance
Section
He-W 844.01 Personal Interview
PARTS
He-W 845 through 847 RESERVED
PART
He-W 848 RESIDENTIAL CARE FACILITIES AND
COMMUNITY RESIDENCES
Section
He-W 848.01 RESERVED
Section
He-W 848.02 Residential Care Facilities
Section
He-W 848.03 Community Residences
PARTS
He-W 849 through He-W 851 RESERVED
PART He-W
852 INCOME – BASIC PRINCIPALS
Section
He-W 852.06 Fluctuating Income
Section
He-W 852.07 Developing Potential Sources
of Income or Benefits
PART
He-W 853 RESERVED
PART
He-W 854 EVALUATION AND TREATMENT OF INCOME
Section
He-W 854.02 Income Computation
Section
He-W 854.15 Adult Category Earned Income
Disregard
Section
He-W 854.16 Adult Standard Disregard
Section
He-W 854.17 Post-Eligibility Computation
of Cost of Care for Nursing Facility Care
Section
He-W 854.18 Adult Employment Expense
Disregard
Section
He-W 854.20 Allowable Deductions
PART He-W
855 - RESERVED
PART
He-W 856 - RESOURCES
Section
He-W 856.01 Resources – Basic Principles
Section
He-W 856.02 Treatment of Specific Types
of Resources
Section
He-W 856.03 Jointly Owned Resources
Section
He-W 856.04 Personal Property Resources
Section
He-W 856.05 Real Property Resources
Section
He-W 856.06 Resource Limits
PART
He-W 857 - RESERVED
PART
He-W 858 STANDARD OF NEED
Section
He-W 858.01 – 858.03 RESERVED
Section
He-W 858.04 Protected Income Level
Section
He-W 858.05 Eligibility for Adult Category
Medical Assistance Nursing Care
Section
He-W 858.06 Eligibility for Adult Category
Medical Assistance for Home and Community-Based Care Choices for Independence
(HCBC0CFI), Home and Community-Based Care for the Developmentally Disabled
(HCBC-DD), Home and Community-Based Care for Individuals with an Acquired Brain
Disorder (HCBC-ABD), and Home and Community-Based Care for In-Home Supports
(HCBC-HIS)
PARTS He-W 859 through He-W 863 & PARTS He-W 865 through
He-W 875 RESERVED
PART He-W 864
MEDICALLY NEEDY MEDICAL ASSISTANCE
Section
He-W 864.01 RESERVED
Section He-W 864.02 Parents and Other Caretaker Relatives Medically
Needy Medical Assistance
PART
He-W 876 NURSING FACILITIES
Section
He-W 876.01 Financial Eligibility for
Nursing Facilities
PART
He-W 877 RESERVED
PART
He-W 878 IN AND OUT MEDICALLY NEEDY
MEDICAL ASSISTANCE
Section
He-W 878.01 In and Out Medically Needy
Medical Assistance
PART
He-W 879 RESERVED
PART
He-W 880 INITIATION OF MEDICAL
ASSISTANCE
Section
He-W 880.01 Initiation of Medical
Assistance
Section
He-W 880.02 Retroactive Medical
Assistance
PART He-W
881 Reserved
PART
He-W 882 TERMINATION OF MEDICAL ASSISTANCE
Section He-W 882.01 Termination of Medical Assistance
Sections He-W
882.02 – He-W 882.03 Reserved
Section He-W 882.04 Four Month Extended Medical Assistance Due to
New or Increased Spousal Support
Section
He-W 882.05 Twelve Month Extended
Medical Assistance
PARTS He-W
883 RESERVED
PART 884 REDETERMINATIONS OF ELIGIBILITY
Section
He-W 884.01 Redeterminations – General
Section
He-W 884.02 Regularly Scheduled
Redeterminations
PARTS He-W
885 through He-W 894 RESERVED
PART He-W
895 UNDUE HARDSHIP
Section
He-W 895.01 Purpose
Section
He-W 895.02 Definitions
Section
He-W 895.03 Waiver of Recovery
Section
He-W 895.04 Criteria for Determination
of Undue Hardship
Section
He-W 895.05 Request for Undue Hardship
Section
He-W 895.06 Undue Hardship Request
Review
Section
He-W 895.07 Reduction from Claim Against
Non-Probate Assets
Section
He-W 895.08 Administrative Hearings
PARTS He-W
896 through He-W 898 RESERVED
PART
He-W 899 SPECIAL PAYMENT SITUATIONS
Section
He-W 899.01 RESERVED
Section
He-W 899.02 Post Office Boxes and General
Delivery Mailing Addresses
TABLE
OF CONTENTS
CHAPTER He-W
900 OTHER PROGRAMS ADMINISTERED BY
THE DEPARTMENT OF HEALTH AND HUMAN SERVICES
PART He-W 910 EXPANDED HEALTH CARE COVERAGE FOR CERTAIN
LOW-INCOME CHILDREN - REPEALED
PART He-W 950 COMPREHENSIVE HEALTH CARE INFORMATION SYSTEM
PROCEDURES FOR THE RELEASE OF CLAIMS DATA SETS FOR PUBLIC AND RESEARCH PURPOSES
Section He-W 950.01 Purpose
Section He-W 950.02 Scope
Section He-W 950.03 Definitions
Section He-W 950.04 Release of Public Use Data Sets
Section He-W 950.05 Release of Limited Use Data Sets
Section He-W 950.06 Claims Data Release Advisory Committee
Section He-W 950.07 Fees
Section He-W 950.08 Exemption from Rule
Section He-W 950.09 General Limitation