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
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:
(1) Is typically manifested in:
a. Impaired social interaction;
b. Problems with verbal and nonverbal
communication and imagination; and
c. Unusual or severely limited activities and
interests;
(2) Has symptoms that generally appear during the
first 3 years of childhood and continue throughout life; and
(3) Includes:
a. Autistic disorder;
b. Pervasive developmental disorder – not
otherwise specified;
c. Asperger’s syndrome;
d. Rett’s syndrome; and
e. Childhood disintegrative disorder.
(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
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
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 provided by the
bureau; 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. Autistic disorder;
b. Asperger’s syndrome;
c. Pervasive developmental disorder, not
otherwise specified (PDD-NOS);
d. Rett’s syndrome; or
e. Childhood disintegrative disorder; 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
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
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:
(1) Providers;
(2) Insurers;
(3) Managed care organizations;
(4) Researchers; and
(5) Governmental agencies.
Source. #9161, eff 5-17-08
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 decision-making authority of persons 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
He-M 503.02 Definitions. The words and phrases used in these rules
shall mean the following:
(a)
“Advanced crisis funding” means revenue authorized by the bureau when
funds are not otherwise available for an individual who is in crisis and needs
services immediately.
(b)
“Applicant” means any person who requests services under RSA 171-A.
(c)
“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.”
(d)
“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.
(e) “Autism” means a condition first appearing in
the very early years of life, which might be characterized by extreme
withdrawal, language disturbance, difficulty in forming affective ties,
frequent lack of responsiveness to other people, monotonously repetitive motor
behaviors, inappropriate response to external stimuli, an obsessive urge for
the maintenance of sameness or impaired intellectual capacities, and
constitutes a severe disability to such individual’s ability to function
normally in society.
(f)
“Basic service agreement” means a written agreement between the
individual or guardian and the area agency that is prepared for each individual
receiving services and that outlines the services and supports to be provided.
(g)
“Bureau” means the bureau of developmental services of the department of
health and human services.
(h)
“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.
(i)
“Commissioner” means the commissioner of the department of health and
human services.
(j)
“Conditional eligibility” means a category of eligibility where a person
under the age of 21 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.
(k)
“Developmental disability” means “developmental disability” as defined
under RSA 171-A:2, V, namely, “a disability:
(1) Which is attributable to mental retardation,
cerebral palsy, epilepsy, autism or a specific learning disability, or any
other condition of an individual found to be closely related to mental
retardation as it refers to general intellectual functioning or impairment in
adaptive behavior or requires treatment similar to that required for mentally
retarded individuals; 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.”
(l)
“Epilepsy” means a neurological condition characterized by recurrent
seizures which might be accompanied by loss of consciousness, convulsive
movements, and/or disturbances of feeling, thought, or behavior and constitutes
a severe disability to such individual’s ability to function normally in
society.
(m) “Expanded service agreement” means a written
agreement between the individual or guardian and the area agency that describes
personal care or day services pursuant to He-M 1001, He-M 521, He-M 524 and
He-M 507.
(n)
“Family support coordinator” means an area agency staff member who
provides assistance to families in accordance with He-M 519.04.
(o)
“Guardian” means a person appointed pursuant to 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.
(p)
“Individual” means a person who has a developmental disability who is
eligible to receive services pursuant to He-M 503.03.
(q)
“Informed consent” means a decision made voluntarily by an individual or
applicant for services or, where appropriate, such person's legal guardian,
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.
(r)
“Local education agency” (LEA) means a local school district as defined
in Ed 1102.31.
(s)
“Mental retardation” means “mental retardation” as defined under RSA
171-A-2, XIV.
(t)
“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 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 or guardian, as applicable,
prefers not to have this included in the profile.
(u)
“Projected service needs list” means a list of the names of the
individuals who do not currently require services but who will within the
current fiscal year or during any of the subsequent 4 fiscal years, or
individuals whose service needs are being met but who will have an increased
need for services within the current fiscal year or during any of the subsequent
4 fiscal years.
(v)
“Provider” means a person receiving any form of remuneration for the
provision of services to an individual.
(w) “Provider agency “means an area
agency or another entity under contract with an area agency to provide
services.
(x)
“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.”
(y) “Routine support services” means the specific
assistance that an individual needs for personal care, communication, mobility,
community participation, emotional and behavioral supports, and safety and
health maintenance, under each service category, such as residential services
under He-M 1001 or day services under He-M 507.
(z)
“Self-directed services” means a service arrangement whereby the
individual, or guardian if applicable, designs the services, selects the
service providers, and decides how the authorized funding is to be spent based
on the needs identified in the individual’s service agreement.
(aa)
“Service” means any paid assistance to the individual in meeting his or
her own needs provided through the area agency.
(ab)
“Service agreement” means a written agreement between the individual or
guardian and the area agency 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
503.11.
(ac) “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.
(ad)
“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.
(ae)
“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, mental retardation, emotional
disturbance, or environmental, cultural, or economic disadvantage.
(af)
“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.
(ag)
“Vacancy” means funds that become available when an individual leaves
developmental services.
(ah) “Wait list” means a list of individuals who
need and are ready to receive services but who do not have funding for services
needed.
(ai) “Withdrawal” means the choice of an
individual or his or her 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
He-M 503.03 Eligibility for Services.
(a)
Pursuant to RSA 171-A, and as referenced in He-M 503.02 (k), any
resident of New Hampshire who has a developmental disability shall be eligible
for services.
(b) Persons who are age 3 to 21, have a
developmental disability, and receive education or educationally-related
services from
(1) Service coordination;
(2) Family support services pursuant to He-M 519;
(3) Respite services pursuant to He-M 513; and
(4) Other services that have been requested and
that are not the legal responsibility of the local education agency (LEA), the
division of children, youth and families (DCYF)
or another state agency to provide.
(c)
Children from birth to 21 who have a developmental disability and who
live at home shall be eligible for in-home support services if the requirements
of He-M 524.03 are met.
(d)
Children under age 3 who do not have a developmental disability shall be
eligible for family-centered early supports and services if they meet the
requirements of He-M 510.05.
(e) Children receiving family-centered early
supports and services pursuant to He-M 510 shall be eligible for family support
services pursuant to He-M 519 and respite services pursuant to He-M 513.
(f) A person under the age of 21 who has a
disability cited in He-M 503.02 (k) 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 21.
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
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; or
(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.
(b)
An application for services shall be made in writing to the area agency
in the individual’s region of residence.
(c)
An area agency shall explain the eligibility process and offer
assistance to the applicant or guardian in making application for services.
(d)
The area agency shall inform the applicant or guardian of its roles and
responsibilities and provide information about:
(1) Evaluation;
(2) Eligibility determination;
(3) Service coordination;
(4) Service agreement development and review;
(5) A listing of the services provided by the
area agency and assistance with identifying the services that are needed;
(6) Service provision; and
(7) Service monitoring.
(e)
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 (a) 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.
(f)
Children served in early supports and services under He-M 510 who are
determined to be ineligible pursuant to He-M 503.05 shall no longer receive
area agency services.
(g) An area agency shall request applicants to
authorize release of information to permit the area agency to access relevant
records and information regarding the person’s:
(1) Developmental disabilities;
(2) Personal, family, social, educational,
psychological, and medical history; and
(3) Functional abilities, interests, and
aptitudes.
(h)
Authorization to release information shall specify:
(1) 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.
(i)
To provide comprehensive, efficient, and coordinated services, the area
agency shall undertake a review of the public and private benefits and
resources which are available to the applicant.
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
He-M 503.05 Determination of Eligibility.
(a) The area agency shall determine the existence
of each applicant’s developmental disability by completing:
(1) 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, an evaluation of the applicant’s physical,
intellectual, cognitive and behavioral status, and an age-appropriate
functional assessment, whichever is needed to complete the assessment.
(b)
The results of the evaluation and any other information concerning the
applicant’s disability shall be the basis for determination of eligibility for
services pursuant to He-M 503.03.
(c)
To the extent possible, the area agency shall utilize generic resources
to pay for an applicant’s 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 application,
make a decision on the eligibility of the applicant in accordance with He-M
503.03. If the information required to
determine eligibility cannot be obtained within these timelines, the area
agency shall request an extension from the applicant or guardian, 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 bureau 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 or guardian, 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 or guardian, the area agency shall determine the
applicant to be ineligible for services.
The individual, family, or guardian may reapply for services pursuant to
(j) below.
(g)
The area agency director 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 whom the area agency
director believes is likely to have a developmental disability, based upon
available information. Such services
shall meet the criteria set forth in He-M 503.08.
(h)
Within 3 business days of the determination of an individual’s
eligibility, an area agency shall convey to each applicant or guardian a letter
which includes the determination of eligibility and identifies a contact person
at the area agency. Preliminary planning
to determine the services needed shall occur with the individual and family at
the time of intake or during subsequent discussions. Pursuant to He-M 503.07 (a), such planning
shall be completed no later than 5 business days from the determination of
eligibility.
(i)
Within 3 business days of determination of an individual’s
ineligibility, an area agency shall convey to the applicant or guardian 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 individual in writing and verbally of the appeal rights under
He-M 503.18.
(j)
Following denial of eligibility, the individual, family, or guardian, as
applicable, may reapply for services if new information regarding the
diagnosis, age of onset or severity of the disability becomes available.
(k)
The determination of eligibility by one area agency shall be accepted by
every other area agency of 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
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07
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 21.
(b)
To determine whether the individual is unconditionally eligible, the
area agency shall, at minimum, arrange for reassessment(s):
(1) Anytime during the ages of 7 through 9;
(2) Anytime during the ages of 12 through 14; and
(3) One year prior to the individual’s 21st
birthday.
(c)
If any of the reassessments pursuant to (b) above, or any other
information obtained subsequent to finding an individual conditionally
eligible, demonstrates to the area agency that a person is unconditionally
eligible for services, any subsequent required reassessments to determine
eligibility shall not be performed.
(d)
If the results of any of the reassessments, or any other information
obtained subsequent to finding an individual conditionally eligible,
demonstrate to the area agency that the individual’s disability will continue
indefinitely or the diagnosis is conclusive as defined in He-M 503.02 (k), the
area agency shall determine him or her eligible for services and so inform the
individual or guardian in writing.
(e) If the results
of any of the reassessments demonstrate that the person does not meet the
criteria as defined in He-M 503.02 (k), the area agency shall inform the person
or guardian in writing and phase out services over the 12 months following the
redetermination.
(f)
In each instance where the redetermination leads to a denial of
eligibility, the area agency shall, in writing, inform the
individual or guardian of the determination and describe the specific legal and
factual basis for the denial including specific citation of the applicable law
or department rule, and advise the individual in writing and verbally of the
appeal rights under He-M 503.18.
(g)
A person or guardian may appeal a denial of eligibility based on
redetermination pursuant to He-M 202.
For the purposes of He-M 503, the term “director” in He-M 202 shall mean
“commissioner.”
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
He-M 503.07 Preliminary Recommendations for Services.
(a)
Within 5 business days of the determination of eligibility, the area
agency shall have conducted sufficient preliminary planning with the individual
and guardian at the time of intake or during subsequent discussions to:
(1) Identify and document the specific services
needed based on information obtained pursuant to He-M 503.05 (a); and
(2) Determine if funding for services is
available.
(b)
If funding for any of the services needed by the individual is
available, the area agency shall designate a service coordinator responsible
for developing a service agreement with the individual in accordance with He-M
503.10 and He-M 503.11.
(c)
If funding for the individual is not available but the individual needs
services currently, the area agency shall:
(1) Place the individual’s name on the wait list
or the projected service needs list in accordance with He-M 503.14 (b), (c),
and (d);
(2) Review available resources to provide partial
assistance to the individual on an interim basis whenever possible;
(3) Help the individual access supports from
sources external to the area agency; and
(4) Document quarterly contact with the
individual or guardian to update information.
(d)
If the individual’s need for services will exist during the current
fiscal year, the area agency shall:
(1) Place the individual’s name on the projected
service needs list in accordance with He-M 503.14 (b) and (d); and
(2) Document quarterly contact with the
individual or guardian to update information.
(e)
If the individual’s need for services will not exist until the following
fiscal year or further into the future, the area agency shall:
(1) Place the individual’s name on the projected
service needs list; and
(2) Document annual contact with the individual
or guardian to update information.
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
He-M 503.08 Service Guarantees on Services for Which
Funds Are Available.
(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 or guardian;
(3) Comply with the rights of the individual
established under RSA 171-A:13-14 and rules adopted thereunder; 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, adult education and leisure activities;
(3) Promote the individual’s health and safety;
(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; and
(9) 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 promote that individual’s freedom of
movement, ability to make informed decisions, self-determination, and
participation in the community.
(d)
An individual or guardian may select any person, any provider agency, or
another area agency as a provider to deliver one or more of the services
identified in the individual’s service agreement. All providers shall comply with the rules
pertaining to the service(s) offered and meet the provisions specified within
the individual’s service agreement. They
shall also enter into a contractual agreement with the area agency and operate
within the limits of funding authorized by it.
(e)
After discussions with the individual, guardian, and proposed or current
provider, if the area agency determines that a provider chosen by the
individual or guardian 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
or guardian stating the reasons why the area agency will not enter into a
service contract with the provider; and
(2) With input from the individual or guardian,
identify another provider.
(f) After
discussions with the individual, guardian, and proposed or current provider, if
the area agency determines that a provider chosen by the individual or guardian
is not acting in the best interest 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 or guardian,
establish another service arrangement and amend the service agreement.
(g)
If the area agency determines that a provider chosen by the individual
or guardian is posing an immediate and serious threat to the health or safety
of the individual, the area agency shall, with input from the individual or
guardian, secure another provider and issue a notice to immediately terminate
the service contract of the current provider, specifying the reasons for the
action.
(h)
The individual or guardian 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 or guardian in
writing and verbally of his or her appeal rights under He-M 503.18.
(i) No one shall be denied an opportunity for
services on the basis of the severity of his or her developmental disability.
(j)
An area agency shall create service agreements for all individuals for
whom funding for services is available, with the exception of those individuals
or families who request only information and referral.
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
He-M 503.09 Service Coordination.
(a)
The service coordinator shall be a person chosen or approved by the
individual or guardian and approved by the area agency, provided that the area
agency shall retain ultimate responsibility for service coordination.
(b)
The service coordinator shall:
(1) Advocate on behalf of individuals for
services to be provided in accordance with He-M 503.08 (b);
(2) Coordinate the service planning process in
accordance with He-M 503.08, He-M 503.10, and He-M 503.11;
(3) Describe to the individual or guardian
service provision options such as self-directed 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 503.11 (b)(7), (f)(1), and (i)(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 when health or safety issues have arisen;
(8) Convene
service planning meetings at least annually and whenever:
a. The individual or guardian 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; or
d. There is a need for a new provider; and
(9) Document
service coordination visits and contacts pursuant to He-M 503.10 (j) and He-M
503.11 (i) (2)-(4).
(c) A service coordinator shall not:
(1) Be a guardian 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-E 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.
(d) If the service coordinator chosen by the
individual or guardian 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 503.09 for
which the service coordinator assumes responsibility;
b. The reimbursement, if any, provided by the
area agency to the service coordinator; and
c. The oversight activities to be provided by
the area agency;
(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 or guardian, pursuant to
He-M 503.09 (a); and
(3) If the area
agency determines that a service coordinator chosen by the individual or
guardian 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 or guardian, pursuant to He-M 503.09 (a).
(e)
The individual or guardian may appeal the area agency’s decision under
He-M 503.09 (d) (2) or (3) about a service coordinator pursuant to He-M
503.18. At the time it provides notice
under He-M 503.09 (d) (2) or (3) the area agency shall advise the individual or
guardian verbally and in writing of his or her appeal rights under He-M 503.18.
(f)
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.
(g)
For individuals who receive services from both the developmental
services and behavior 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 426.13 (e).
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
He-M 503.10 Service Planning.
(a)
Service coordinators shall facilitate service planning to develop
service agreements in accordance with He-M 503.11.
(b) All service planning shall:
(1) Be a personalized and ongoing process to
plan, develop, review, and evaluate the individual’s services in accordance
with the criteria set forth in He-M 503.08; and
(2) Include identification by the individual or
guardian and the individual’s service providers of those services and
environments that will promote the individual’s health, welfare, and quality of
life.
(c)
The service coordinator shall, as applicable, maximize the extent to
which an individual participates in and directs his or her service planning
process by:
(1) Explaining to the individual the
service planning process and assisting the individual to determine the process
within the scope of He-M 503;
(2) Explaining to the individual his
or her rights and responsibilities;
(3) 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;
(4) Determining with the individual issues to be
discussed during 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.
(d)
The individual or guardian 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; and
(4) Topics to be discussed.
(e)
In order to develop or revise a service agreement to the satisfaction of
the individual or guardian, the service planning process shall consist of periodic
and ongoing discussions regarding elements identified in He-M 503.08 (b) that:
(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.
(f)
The service planning process shall include a discussion of the need for
guardianship. The area agency director
shall implement any recommendations concerning guardianship contained in the
service agreement.
(g)
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.
(h)
Service agreements shall be reviewed by the area agency with the
individual or guardian at least once during the first 6 months of service and
as needed. The annual review required by
He-M 503.09 (b)(8) shall include a service planning meeting.
(i)
The individual or guardian may request, in writing, a delay in an
initial or annual service agreement meeting.
The area agency shall honor this request.
(j)
The service coordinator shall be responsible for monitoring services
identified in the service agreement and for assessing individual, family or
guardian satisfaction at least annually for basic service agreements and
quarterly for expanded service agreements.
(k)
An area agency director, service coordinator, service provider,
individual, guardian, or individual’s friend shall have the authority to
request a service agreement 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.
(l) At a meeting held pursuant to (k) above, the
participants shall document whether and how to modify the service agreement.
(m) Service agreement amendments may be proposed
at any time. Any amendment shall be made
with the consent of the individual or guardian and the area agency.
(n) If the individual, guardian, or area agency
director disapproves of the service agreement, the dispute shall be resolved:
(1) Through informal discussions between the
individual or guardian and service coordinator;
(2) By reconvening a service planning meeting; or
(3) By the individual or guardian filing an
appeal to the bureau pursuant to He-C 200.
(o)
Documentation of amendments shall be made on the “amendments to service
agreement” form.
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
He-M 503.11 Service Agreements.
(a) The area agency shall create service
agreements for all individuals for whom funding for services is available, as
follows:
(1) The basic
service agreement shall be completed pursuant to (b) below; and
(2) For
services provided under He-M 1001, He-M 521, He-M 524, or He-M 507, or per
individual or guardian request, an expanded service agreement shall be
developed pursuant to (c)-(h) below.
(b) Within 15 business days of the area agency’s
identification of the availability of funding for an individual, the service
coordinator shall meet with the individual, family, and guardian, if applicable,
and others that the individual or guardian would like to have present and
develop a written basic service agreement, signed by the individual or guardian
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 specific services to be furnished;
(3) The amount, frequency, duration and desired
outcome of each service;
(4) Timelines for initiation of services;
(5) The provider to furnish the service;
(6) The individual’s need for guardianship, if
any;
(7) Service documentation requirements sufficient
to track outcomes; and
(8) For individuals with a self-directed service
arrangement, reporting mechanisms regarding budget updates and individual and
guardian satisfaction.
(c) The service coordinator shall convene a
meeting to prepare an expanded service agreement in accordance with (d)-(h)
below within 20 business days of the initiation of services provided under He-M
1001, He-M 521, He-M 524, or He-M 507, or when requested by the individual or
guardian.
(d) 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.
(e)
Copies of relevant evaluations and reports shall be sent to the
individual and guardian at least 5 business days before service planning meetings.
(f)
Within 10 business days following a service planning meeting pursuant to
(c) above, the service coordinator shall:
(1) Prepare a
written expanded service agreement that:
a. Includes the following:
1. A personal profile; and
2. A list of those who participated in the
service planning agreement meeting; and
b. Describes the following:
1. The specific support services to be provided
under each service category;
2. The goals to be addressed, and timelines and
methods for achieving them;
3. The persons responsible for implementing the
expanded service agreement;
4. Services needed but not currently available;
5. Service documentation requirements sufficient
to describe progress on goals and the services received;
6. If applicable, reporting mechanisms under
self-directed services regarding budget updates and individual and guardian
satisfaction with services; and
7. 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 and confirm that they are to the individual’s and
guardian’s satisfaction.
(g)
Within 5 business days of completion of the service agreement, the area
agency shall send the individual or guardian 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 503.18 for
those situations where the individual or guardian disapproves of the expanded
service agreement.
(h)
The individual or guardian 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 or guardian and the area agency, failure to respond within the time
allowed shall constitute approval of the service agreement.
(i) When an expanded service agreement has been
approved by the individual or guardian 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. 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, HeM-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.
(j)
Service agreements shall be renewed at least annually.
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
He-M 503.12 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 503.04 (h) 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 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 or next of kin or
other
person to be notified;
b. Name, address, and telephone number of
current service providers; and
c. Medical information as applicable, 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 503.11
(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, 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; and
(11)
Information about transfer or termination of services, as appropriate.
(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 shall comply with all applicable documentation requirements of
other bureau 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.
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
He-M 503.13 Record
Requirements for Provider Agencies.
(a) Provider agencies 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:
(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 or next of kin or
other person to be
notified;
b. Name, address, and telephone number 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 503, each provider agency
shall comply with all applicable documentation requirements of other bureau
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. #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
He-M 503.14 Allocation
of Funds for Current and Future Individual Service Requests.
(a) Funding requests
for current and future services shall be handled by the area agencies and the
bureau through the following processes:
(1) Projected service needs list;
(2) Wait list;
(3) Electronic wait list registry database of (1)
and (2) above; and
(4) Advanced crisis funding.
(b) An area agency
shall maintain projected service needs lists for those individuals who will
need services during the current fiscal year or one of the next 4 fiscal years.
(c) 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.
(d) For individuals
who are already receiving services, the area agency shall place such
individuals’ names on the wait list or projected service needs lists if:
(1) They require a different service; or
(2) Their status has changed.
(e) The area agency
shall document its projected service needs list and wait list by entering the
following information into the electronic wait list registry database at https://services.nhleads.org/:
(1) Name and date of birth of the individual;
(2) The diagnosis that identifies the
individual’s developmental disability pursuant to He-M 503.02 (k);
(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 or projected service needs list;
(9) The date on which, and the reasons for which,
the individual’s name is taken off the wait list or projected service needs
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 or
projected service needs list.
(f) 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;
and
(15) Length of time on the wait list as compared
to others.
(g) 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.
(h) An area agency
shall request advanced crisis funding from the bureau to provide services
without delay when there are no generic or area agency resources available and
an individual is:
(1) A victim of abuse and neglect 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) In need of necessary residential services
that are no longer the legal responsibility of DCYF or LEA;
(6) Presenting a significant risk to community
safety; or
(7) In need of long-term employment funding to
maintain his or her job.
(i) To demonstrate
the need for advanced crisis funding the area agency shall submit to the
bureau, in writing, a detailed description of the individual’s circumstances
and needs and a proposed budget.
(j) The bureau shall
review the information submitted by the area agency and approve advanced crisis
funding if it determines that one of the conditions cited in (h) above applies
to the individual’s situation and the individual’s name has been entered into
the wait list registry.
(k) The bureau shall
utilize funds from statewide individual vacancies in order to finance services
that are approved pursuant to (j) above.
(l) For each request
an area agency makes for funding individual services, the bureau shall make the
final determination on the cost effectiveness of proposed 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 #10372, eff 7-1-13
He-M 503.15 Transfers Across Regions.
(a)
If an individual plans to relocate residency to another region and
wishes to transfer his or her area agency affiliation to that region, the
individual or guardian shall notify in writing the area agency in the current
region and the area agency in the proposed region that he or she is moving and
wishes to transfer services.
(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. #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
He-M 503.16 Termination of Services.
(a)
Any person may make a recommendation for termination of service(s) to an
individual. Any such recommendation
shall be made in writing to the area agency director.
(b)
If termination of services is being considered, the service coordinator
shall meet with the individual or guardian, or both to discuss the reasons for
the recommended termination.
(c)
Any recommendation for termination shall 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.
(d)
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, the individual or guardian, 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 (c) above applies to the individual.
(e)
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.
(f)
The area agency director shall make the final decision regarding
termination based on the criteria listed in (c) above.
(g)
If a decision is made to terminate services pursuant to (f) above, the
area agency director shall send a termination notice to the individual or
guardian at least 30 days prior to the proposed termination date. Service may be terminated sooner than 30 days
with the consent of the individual or guardian.
The individual or guardian may appeal the termination decision in
accordance with He-C 200.
(h)
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 New Hampshire Disabilities Rights Center, which the individual or guardian
may contact for assistance in appealing the decision.
(i)
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 or guardian, in writing, to the area agency
director.
(j)
Upon request of the individual or guardian, the area agency director
shall resume services to the individual if the criteria in (c) 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
(from He-M 503.13)
He-M 503.17 Voluntary Withdrawal from Services.
(a)
An individual or guardian 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, 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 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 or guardian, in writing, to the area agency
director.
(f)
Upon request of the individual or guardian, the area agency director
shall resume services to the individual if funding is available.
Source. #8805, eff 1-27-07 (from He-M 503.14)
He-M 503.18 Challenges and 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. Any determination,
action, or inaction by an area agency may be appealed by an individual or
guardian.
(b) The following actions shall be subject to the
notification requirements of (c) below:
(1) Adverse eligibility actions under He-M 503.05
(d) and (i) and He-M 503.06 (e) and (f);
(2) Area agency determinations regarding an
individual’s or guardian’s selection of provider under He-M 503.08 (e) or
removal of provider under He-M 503.08 (f) and (g);
(3) Area agency determinations regarding the
removal of an individual or guardian’s selected service coordinator under He-M
503.09 (d) (2) and (3); or
(4) A determination to terminate services under
He-M 503.16 (f).
(c) An area agency
shall provide written and verbal notice to the applicant and guardian 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 business days and the process for filing an
appeal, including the contact information to initiate the appeal with the
bureau’s director;
(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; and
(6) Notice of organizations with their addresses and phone numbers that
might be available to provide legal assistance and advocacy, including the
(d) Appeals shall be forwarded, in writing, to
the director 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.
(e) The director 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 204.12.
(f) 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. #8805, eff 1-27-07 (from He-M 503.15)
He-M 503.19 Waivers.
(a)
An area agency, provider agency or individual may request a waiver of
specific procedures outlined in He-M 503 using the form titled “NH bureau of
developmental services waiver request.”
(b)
A completed waiver request form shall be signed by:
(1) The
individual(s) or legal guardian(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:
Office
of Client and Legal Services
State
Office Park South
105
Pleasant Street,
(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 provider agency
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 area agency’s,
provider agency’s, or individual'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 area agency, provider agency, or individual 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. #8805, eff 1-27-07 (from He-M 503.16)
PART
He-M 504 – RESERVED
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
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; 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:
a. Significant decline in cognitive functioning
and ability; and/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 director 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, namely “an entity established as an nonprofit corporation in the state of
New Hampshire which is established by rules adopted by the director to provide
services to developmentally disabled persons in the area.”
(e)
"Area board" means “area board” as defined in RSA 171-A:2,
I-C, namely “governing body 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
505.03 (u).
(g)
"Bureau" means the bureau of developmental services.
(h)
"Commissioner" means the commissioner of the department of
health and human services.
(i)
"Conditional redesignation" means a written ruling by the
commissioner pursuant to He-M 505.09 that an area agency has partially complied
with the redesignation criteria listed in He-M 505.08 and that continued
designation is contingent upon fulfilling the requirements established by He-M
505.
(j)
"Consumer" means:
(1) An individual with a developmental disability
or acquired brain disorder;
(2) An adult who is the mother, father, brother,
sister or spouse of an individual with a developmental disability or acquired
brain disorder; or
(3) The legal guardian, other than a corporate or
public guardian, of an individual with a developmental disability or acquired
brain disorder.
(k)
"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 505.05 and has been approved as the area agency
for the area.
(l)
"Developmental disability" means “developmental disability” as
defined in RSA 171-A:2, V, namely, "a disability:
(1) Which is attributable to mental retardation,
cerebral palsy, epilepsy, autism, or a specific learning disability; or any
other condition of an individual found to be closely related to mental
retardation as it refers to general intellectual functioning or impairment in
adaptive behavior or requires treatment similar to that required for mentally
retarded individuals; and
(2) 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."
(m)
"Director" means the director of the bureau of developmental
services.
(n)
"Generic services" means services available to the general
population that are not specifically designed for individuals.
(o)
“Guardian” means a person appointed pursuant to 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.
(p)
"Individual" means a person who has a developmental disability
or acquired brain disorder.
(q)
"Integrated activity" means personal interaction between
persons with and without developmental disabilities or acquired brain disorders
that occurs within community settings.
(r)
"Integrated setting" means a setting where the majority of
persons are non-handicapped and the primary activity is neither bureau-funded
nor designed primarily for individuals.
(s)
"Interim designation" means a written ruling by the
commissioner pursuant to He-M 505.05 (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.
(t)
“
(u)
"Region" means "area" as defined in He-M 505.02 (b).
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
He-M
505.03 Role and Responsibilities of
the Area Agency.
(a)
The primary responsibility of the area agency shall be to plan,
establish, and maintain a comprehensive service delivery system for individuals
who are residing in the area. The area
agency shall plan and provide these services according to rules promulgated by
the commissioner.
(b)
Pursuant to RSA 171-A:18, I, the area agency shall be the primary
recipient of 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.
(c)
When possible, the area agency shall utilize generic, integrated
services, rather than establish separate services for people with developmental
disabilities.
(d)
Services provided by, or arranged through, an area agency shall:
(1) Facilitate as much as possible the
individual’s ability to determine and arrange the services and supports he or
she will receive, including the involvement of family and friends as identified
by the individual;
(2) Promote the individual’s personal development
and quality of life in a manner that is determined by the individual;
(3) Meet the individual’s needs in personal care,
employment and leisure activities;
(4) Protect the individual’s right to freedom
from abuse, neglect and exploitation;
(5) Promote the individual’s health and safety;
(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 and 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;
(10) Be provided in such a way that the individual
is seen as a valued, contributing member of his or her community; and
(11) Be
in an environment or setting that promotes the person’s freedom of movement,
ability to make informed decisions, self-determination, and participation in
the community.
(e)
The area board shall establish policies and procedures for the
governance and administration of the area agency and all service components of
the area service delivery system.
Policies shall be developed to ensure efficient and effective operation
of the local service delivery system and adherence to requirements of state and
federal funding sources, the area plan, and rules and contracts established by
the department. Policies shall be
developed to ensure that the area agency avoids any conflict of interest and
any appearance of conflict of interest in its business relationships.
(f)
The department shall assist area agencies in the establishment and
provision of services through contract establishment, contract monitoring,
consultation, technical assistance, service reviews, staff and board training,
coordination with other service systems, and other means.
(g)
The area agency shall be incorporated and have an established plan for
governance in accordance with He-M 505.03 (h)-(l) below.
(h)
The area 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.
(i)
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 and ownership and possession
of all assets and property obtained with funds granted by the department shall
revert to the department so that the agency’s assets can be redeployed on
behalf of persons with developmental disabilities or acquired brain disorders.
(j)
The area board shall include in its bylaws 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 of the consumers' terms expiring in the same year.
(k)
The area board shall specify in its bylaws that the maximum consecutive
period during which a board member may serve as an officer of the board shall
not exceed 6 years.
(l)
The area board shall specify in its bylaws a procedure by which inactive
members are removed from the area board.
(m)
The size and composition of the area 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) Consumers shall comprise at least 1/3 of the
membership of the area board;
(4)
Members shall be representative of the agency's different consumer groups and
entire geographic area; and
(5) Membership shall be open to all 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.
(n)
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. The area board shall submit to the
commissioner those applications that comply with these rules. The commissioner or his or her designee shall
review and approve in writing those that comply with He-M 505.03 (m) (5) and
He-M 505.05 (d) as qualified to sit on the board.
(o)
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.
(p)
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.
(q)
The executive director shall have, at a minimum, 5 years of
administrative experience in human services and 2 years of experience in
developmental service programs. All or part
of the developmental service experience may have been in the above
administrative capacity.
(r)
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.
(s)
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 and the department’s rules, contract provisions, and
mission.
(t)
Pursuant to RSA 171-A:18, V, the area board shall prepare and submit to
the bureau an area plan for the provision of services to individuals in the area.
(u)
The area plan shall:
(1) Clearly identify the extent to which the area
agency has involved its consumers, the regional Family Support Council, the
general public residing in the area and generic service agencies in the
planning and provision of services for individuals;
(2) Demonstrate that services proposed by the
area agency 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; and
b. Consistent with RSA 171-A and the agency’s
and bureau's mission statements and priorities;
(3) Be prepared for a 5-year period that
coincides with the redesignation cycle identified in He-M 505 Table 2;
(4) Be submitted to the commissioner for approval
pursuant to (v) below; and
(5) 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 commissioner 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
region-wide consumer needs, legislation or in area demographics, vendors, or
funding.
(v)
The commissioner or his or her designee shall review area plans and
amendments to area plans submitted for approval pursuant to (u) (4) and (5)
above and approve those plans or amendments that are determined to comply with
the agency mission and department rules and applicable state and federal
legislation.
(w)
The area agency shall be responsible for assuring that appropriate
services are provided in accordance with RSA 171-A and the regulations
promulgated thereunder, including the following:
(1) Coordination of application for services and
eligibility determination process;
(2) Service planning and coordination;
(3) Service agreement development and monitoring;
(4) Provision of services as prescribed in the
service agreement;
(5) Monitoring and safeguarding of rights; and
(6) Periodic assessment of satisfaction with, and
review and continuous improvement of, quality of services.
(x)
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.
(y)
The area agency shall not enter any merger, sale, affiliation or other
substantial change in its corporate identity without the prior approval of the
director. The director shall review any
proposed merger, sale, affiliation or other substantial change in the corporate
identity of an area agency. The director
shall approve such proposed changes if the director determines that the
resulting organization retains sole policy-making authority and responsibility
for the region’s services and such proposed changes ensure the agency can
adequately carry out the responsibilities of an area agency, comply with the
rules of the department, and are in the best interest of individuals residing
in the region.
(z)
The services for which the area agency is responsible 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 fiscal management responsibility to any person or
organization. Any agreement involving department funds, including Medicaid,
entered into by the area agency for the provision of services shall be approved
by the commissioner pursuant to He-M 505.03 (ab).
(aa)
An area agency planning to enter into agreements pursuant to He-M 505.03
(z) shall:
(1) Notify the commissioner of such plans when
the plans involve department-authorized funds; 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.
(ab)
The commissioner shall review the information submitted as described in
(aa) above and approve those agreements that comply with department rules and
applicable state and federal legislation.
(ac)
The area agency shall be responsible and accountable for all area agency
services whether administered directly by the area agency or provided under
contracts with persons or organizations.
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 board.
(ad)
Services shall be operated in compliance with rules and contract
requirements established by the department.
Services shall also comply with the goals and priorities of the approved
area plan.
(ae)
The department shall conduct announced or unannounced reviews of area
agencies and audit area agencies at least every 5 years, including all or part
of any services, finances, or operations of the area agency, whether operated
directly by the area agency or through contracts with persons or organizations.
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
He-M 505.04 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
|
201 |
413 Dummer |
523 |
214 |
|
202 |
511 |
524 |
429 Shelburne |
|
504 |
206 Eaton |
525 |
430 Stark |
|
403 |
207 Effingham |
527 Lyman |
431 Stewartstown |
|
505 |
414 Errol |
211 |
432 |
|
203 |
514 |
422 |
540 Sugar Hill |
|
405 Carroll |
208 Freedom |
428 Millsfield |
215 |
|
204 |
416 Gorham |
529 |
216 Tuftonboro |
|
406 |
209 Hart's Location |
212 Moultonborough |
217 |
|
407 Colebrook |
518 |
424 Northumberland |
536 |
|
408 |
210 |
213 Ossipee |
537 |
|
205 |
418 |
532 Piermont |
436 Whitefield |
|
409 |
420 |
427 |
218 Wolfeboro |
|
412 Dixville |
521 Landaff |
428 |
539 |
Area
II
|
001 Acworth |
510 |
008 Langdon |
531 Orford |
|
509 |
513 |
522 |
011 |
|
002 |
006 |
009 Lempster |
012 |
|
003 |
515 Grafton |
528 Lyme |
013 Sunapee |
|
004 Cornish |
007 Grantham |
010 |
014 Unity |
|
005 Croydon |
517 |
530 |
015 |
Area
III
|
501 |
507 |
516 |
533 |
|
101 |
508 Campton |
519 |
534 Rumney |
|
502 |
104 |
520 Holderness |
110 Sanbornton |
|
102 Barnstead |
512 Ellsworth |
107 |
535 |
|
103 |
105 Gilford |
108 Meredith |
111 Tilton |
|
506 |
106 Gilmanton |
109 New |
538 Wentworth |
Area
IV
|
701 Allenstown |
709 |
716 Hopkinton |
723 |
|
702 |
606 Deering |
717 Loudon |
724 Sutton |
|
703 Boscawen |
710 Dunbarton |
718 Newbury |
725 Warner |
|
704 Bow |
711 Epsom |
719 |
629 Weare |
|
705 |
712 |
720 |
726 Webster |
|
706 |
713 Henniker |
721 Pembroke |
727 Wilmot |
|
707 |
714 Hill |
722 |
631 |
|
708 |
612 Hillsborough |
|
|
Area
V
|
301 Alstead |
610 |
312 Nelson |
317 Sullivan |
|
602 Antrim |
611 Hancock |
624 New |
318 Surry |
|
604 |
306 Harrisville |
626 |
319 Swanzey |
|
302 |
307 |
313 |
628 |
|
303 |
308 Jaffrey |
314 Rindge |
320 |
|
304 Fitzwilliam |
309 |
315 Roxbury |
321 |
|
607 Francestown |
616 Lyndeborough |
627 |
322 Westmoreland |
|
305 Gilsum |
310 |
316 Stoddard |
323 |
|
609 |
311 Marlow |
|
|
Area VI
|
601 |
614 |
619 |
622 |
|
605 |
615 Litchfield |
620 |
630 |
|
613 Hollis |
618 Mason |
621 |
|
Area
VII
|
802 |
804 |
715 Hooksett |
617 |
|
603 |
608 Goffstown |
819 |
623 New |
Area
VIII
|
803 |
813 |
821 Newfields |
829 |
|
807 |
815 |
822 |
830 Raymond |
|
809 East |
816 |
823 |
831 |
|
810 Epping |
817 Kensington |
825 North |
834 Seabrook |
|
811 |
818 |
826 Northwood |
835 South |
|
812 |
820 |
827 |
836 Stratham |
Area
IX
|
901 |
905 Lee |
908 |
911 Rollinsford |
|
902 |
906 Madbury |
914 New |
912 Somersworth |
|
903 |
907 Middleton |
910 |
913 Strafford |
|
904 |
|
|
|
Area
X
|
801 Atkinson |
808 |
625 Pelham |
833 Sandown |
|
805 |
814 Hampstead |
828 Plaistow |
837 |
|
806 |
824 |
832 |
|
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
He-M 505.05 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 regional 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
505.05 (d), and He-M 505.03 (m) 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;
(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 505.03 (m)(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 and consumer-directed services.
(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;
(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
rules;
(4) The applicant group that is determined to be
able to best comply with the 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 505.06 or He-M 505.07 or unless an
agency applies for redesignation in accordance with He-M 505.08;
(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 region 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 505.11.
(f)
An agency that has had its status as an area agency revoked in
accordance with He-M 505.06 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 505.04, the commissioner shall select one area agency as the designated
area agency for the new consolidated region using the criteria identified in
He-M 505.08 (e)-(f). 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 #8443, eff 1-1-06;
ss by #8928, eff 6-30-07
He-M 505.06 Revocation of Designation.
(a)
The commissioner shall monitor the services provided by the area agency to
assure that area agency services are operated in accordance with the
department’s rules, contract provisions, and mission statement, and the area
plan. In the event that the commissioner
determines that the area agency is not providing such services in accordance
with said rules, contract, plan, or mission, the commissioner 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. Such notice shall specify when the remedial
action shall be completed. All remedial
action shall occur within 60 days of the date of notification.
(b)
In the event that the commissioner determines that the area agency has
not complied with the remedial action requested pursuant to (a) above, the
commissioner shall revoke the area agency’s designation.
(c)
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.
(d)
An area agency may request a revocation hearing in accordance with He-M
505.11.
(e)
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 505.05.
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
He-M 505.07 Suspension.
(a)
If the commissioner finds at any time that the health, safety, or
welfare of individuals with disabilities 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 his or her designee shall conduct a hearing on the
suspension within 10 days of its issue.
Such a hearing shall be conducted pursuant to RSA 54l-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 505.05.
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
He-M
505.08 Redesignation.
(a)
Each area agency shall apply to the director for redesignation every 5
years. 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.
(b) Area agencies shall submit applications for
redesignation 90 days prior to the expiration of its current redesignation
according to table 505-2 below:
Table
505-2, Redesignation Schedule
|
2006 |
2007 |
2008 |
2009 |
2010 |
|
Region
3 |
Region
7 |
Region
4 |
Region
1 |
Region
2 |
|
Region
6 |
Region
10 |
Region
9 |
Region
8 |
Region
5 |
(c)
The application deadline for redesignation shall be September 30 of each
year. Submission of an application
pursuant to (b) above shall cause the area agency’s current designation to be
effective until the commissioner issues a decision pursuant to (e) below.
(d)
The commissioner shall consider the area agency’s past and current
success in providing supports and services to individuals and their families.
(e)
An area agency shall be considered successful and operating efficiently
when it:
(1) Demonstrates, through
its services and supports, 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
regional planning, system design, and development;
(5) Continuously assesses and 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, providers 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 state and federal requirements.
(9) Achieves the goals identified in its area
plan and implements the recommendations made in its previous redesignation
report from the department.
(f)
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 (e) (1)-(9) above:
(1) Public comments regarding the area agency’s
demonstrated ability to provide local services and supports to individuals and
their families;
(2) A comprehensive self-assessment of the area
agency’s current abilities and past performance;
(3) Input from a wide range of people, agencies,
or groups who are either recipients, providers, or people who collaborate in
the provision of services and supports;
(4) Documentation pertaining to area agency
operations available regionally and at the department; and
(5) Input from department staff who have direct
contact with and knowledge of area agency operations.
(g)
Department staff designated by the commissioner shall issue a written
report and recommend redesignation or conditional redesignation of the area
agency.
(h)
An area agency shall respond to any corrective action request included
in a letter of redesignation within 90 days of the letter.
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
He-M 505.09 Conditional Redesignation.
(a)
If the area agency fails to meet the redesignation criteria specified in
He-M 505.08, 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 director shall review and issue a
written report regarding the area agency's progress toward compliance with the
conditions identified pursuant to He-M 505.09 (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
He-M 505.10 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. Such a notice shall specify
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 the notice of denial. 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 505.11.
(b)
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 505.05.
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
He-M 505.11 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 his or her 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
He-M 505.12 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 505.05 to designate a successor area
agency.
(b)
Pursuant to RSA l7l-A:l8, 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. #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
He-M 505.13 Waivers.
(a)
An area agency or applicant group may request a waiver of specific
procedures outlined in He-M 503 using the form titled “NH Bureau of
Developmental Services Waiver Request.”
(b)
A waiver request shall be submitted to:
Office
of Client and Legal Services
State
Office Park South
105
Pleasant Street,
(c)
No provision or procedure prescribed by statute shall be waived.
(d)
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 or applicant group 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.
(e)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(f)
Upon receipt of approval of a waiver request, the area agency’s or
applicant group '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)
An area agency or applicant group 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. #6871, eff 10-21-98; ss by #8728, INTERIM,
eff 10-21-06, EXPIRED: 4-19-07
New.
#8928, eff 6-30-07
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
(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
(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
(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
105 Pleasant Street,
(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)
129 Pleasant
Street,
(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
(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
(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
(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
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
105 Pleasant
Street,
(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 (f), 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
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.”
(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) “At risk for
substantial developmental delay” means that a child experiences 5 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 addiction;
g. Age of either parent less than 18 years;
h. Parent/child interactional disturbances; or
i. Founded child abuse or neglect as determined
by a district court pursuant to RSA 169-C:21.
(e) “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.
(f) “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.
(g) “Commissioner”
means the commissioner of the
(h) “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 and can be revoked at any time.
(i) “Department” means the
(j) “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.
(k) “Early
intervention specialist” means an individual certified by the bureau in
accordance with the criteria in He-M 510.11 (k)-(m).
(l) “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) An inborn metabolic fault;
(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) Developmental delay secondary to severe toxic
exposure.
(m) “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 his or her needs in a flexible manner and that includes:
(1) Information;
(2) Training;
(3) Special instruction;
(4) Evaluation;
(5) Therapeutic interventions;
(6) Financial assistance;
(7) Materials and equipment;
(8) Emotional support; and
(9) Any of the services in He-M 510.03 (a)-(v).
(n) “Family-centered
early supports and services (FCESS) program” means a program under contract with
the department to provide FCESS as defined in these rules.
(o) “Family support
council” means the regional council established pursuant to RSA 126-G:4.
(p) “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.
(q) “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.
(r) “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.
(s) “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.
(t) “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.
(u) “Length” means
the period of time the service is provided during each session of that service.
(v) “Local education
agency (LEA)” means “local education agency” as defined in Ed 1102.03 (o).
(w) “Medical home”
means a model of delivering primary care that is accessible, continuous,
comprehensive, family-centered, coordinated, compassionate, and culturally
effective.
(x) “Method” means
how a service is provided.
(y)
“Multidisciplinary” means the involvement of 2 or more individuals from
separate disciplines or professions.
(z) “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.
(aa) “Natural
environment” means places and situations where the child’s age peers without
disabilities live, play, and grow.
(ab) “Natural
supports” means people including but not limited to family, relatives, friends,
neighbors, child care providers, and 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.
(ac) “Notification” means referral of a child to the LEA
and the NH department of education.
(ad) “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 (p) 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 (am) below;
or
e. Any other individual who is legally
responsible for the child’s welfare.
(ae) “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.
(af) “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.
(ag) “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.
(ah) “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) Film;
(6) Microfilm; and
(7) Microfiche.
(ai) “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.
(aj)
“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).
(ak) “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.
(al) “Setting” means
the actual place(s) the services will be provided.
(am) “Surrogate
parent” means a person who:
(1) Is appointed and trained pursuant to Ed 1115;
(2) Is trained regarding FCESS; and
(3) Acts as a child’s advocate in the FCESS
decision-making process 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
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 a commercially available, modified, or customized
assistive technology device such as any item, piece of equipment, or product
system that is designed to increase, maintain, or improve the functional
capabilities of the child, 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,
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) “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.
(c) 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.
(d) 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.
(e) 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.
(f) 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.
(g) 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.
(h) 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.
(i) 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.
(j) 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 (j)(1)
above; and
(3) Making referrals to appropriate community
resources to carry out nutrition goals.
(k) 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.
(l) 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.
(m) Preventative and
diagnostic services shall be early and periodic screening, diagnosis, and
treatment services as specified in He-W 546.05 (a) and (b).
(n) 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.
(o) 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.
(p) 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.
(q) Sign language
and cued language services shall include:
(1) Teaching sign language, cued language, and
auditory/oral language;
(2) Providing oral transliteration services, such
as amplification; and
(3) Providing sign and cued language
interpretation.
(r) 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/group
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.
(s) 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.
(t) 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 communicative or language disorders and delays
in development of communication skills.
(u) 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.
(v) Vision services
shall include:
(1) Evaluation and assessment of visual functioning,
including the diagnosis and appraisal of specific visual disorders, delays, and
abilities;
(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.
(w) The services and
personnel identified and defined in (a)-(v) 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.
(x) 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
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)-(v), 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. Friends;
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) Mobilize 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,
eff4-22-08, EXPIRED: 10-19-08
New. #9594, eff 11-11-09; ss by #10325, eff
4-26-13
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
He-M 510.06 Referral
and Eligibility Determination.
(a) Any child who is
a resident of
(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 of the referral;
(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, and 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 an 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 (f); 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 Infant Toddler
Development Assessment (IDA, 1995) or the Hawaii Early Learning Profile (HELP)
0–3 (1992–1996) (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 history;
(8) Include information from others sources such
as family members, other care-givers, 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) As determined through the use of an
assessment tool and a voluntary family-directed personal interview with the
family, 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 and written 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 (f) 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 to 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
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 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 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, 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 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 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 and achieve
the outcomes identified in the IFSP;
(6) The length, frequency and 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, to
which 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,
other than the service coordinator, 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 procedures to prepare the child for changes in service
delivery, including steps to help the child adjust to and function in a new
setting;
b. Confirmation that information about the child
has been transmitted to the LEA or other relevant agency in accordance with
He-M510.09 (f) and (g); and
c. 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 the supports and services 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 supports and services 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 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
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 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
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 his or her 3rd birthday through the remainder of the school year;
(2) Identifies steps for the child and his or her
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 make reasonable efforts to convene a
conference with 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 make reasonable efforts
to convene a conference with 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 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 his or her 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 his or her 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 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
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
(2) Local education agencies;
(3) Visiting nurse associations;
(3) Local hospitals and medical clinics; and
(4) Child care providers.
(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) Monitoring visits to FCESS programs; and
(5) Development and implementation of an
improvement plan based on (1)-(4) above.
(i) Area agencies
and FCESS programs shall enter the information identified below into the
bureau’s statewide data system based on the following schedule:
(1) Upon referral of a child:
a. The child’s name;
b. Parent/guardian contact information;
c. The child’s date of birth;
d. The child’s race and ethnicity;
e. Diagnosis and reason for referral; and
f. Insurance status, as one of the following
types:
1. Public;
2. Private;
3. Both public and private; or
4. None;
(2) Upon eligibility determination:
a. Eligibility status; and
b. Eligibility category;
(3) Following preparation of the IFSP:
a. The date of parent or guardian consent;
b. IFSP services to be provided; and
c. 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 commissioner of
education in accordance with Ed 1115 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)
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)
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 in the area of
blind and vision disabilities;
u. Special education teacher in the area of deaf
and hearing disabilities;
v. Special education teacher in the area of
emotional and behavioral disabilities;
w. Special education teacher in the area of
intellectual and developmental disabilities;
x. Special education teacher in the area of
physical and health disabilities;
y. Special education teacher in area of specific
learning disabilities; and
z. Vision specialist including ophthalmologists
and optometrists;
(2)
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) Training 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 a licensed or certified
professional 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
(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 of a bachelor’s
degree in:
a. Human services;
b. Family studies;
c. Psychology;
d. Child development;
e. Communication;
f. Child life;
g. Education; or
h. Early intervention;
(2) Completion of the orientation program
outlined in He-M 510.12 (b);
(3) A minimum of 2 years’ experience in an FCESS
program for degrees listed in (1) a. - g. above;
(4) A minimum of 6 months’ experience in an FCESS
program for the degree listed in (1) h. above; and
(5) 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 (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; ss by #9135, INTERIM,
eff4-22-08, 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)
He-M 510.12 Personnel
Development.
(a) All new
personnel, 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 orientation
program shall consist of at least 12 hours of training and include information
about:
(1) The philosophy and provision of FCESS;
(2) Provision of service coordination;
(3) Eligibility evaluation and ongoing
assessment;
(4) Procedural safeguards;
(5) State-of-the-art issues 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 his
or her annual personnel development plan an early intervention specialist shall
acquire at least 24 hours of continuing education credit in subject matter
relevant to his or her job description, as determined by the program director.
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)
He-M 510.13 Recordkeeping.
(a) Each program shall
maintain individual family records that contain, at a minimum, the following:
(1) A face sheet at the beginning of the record
that shall include:
a. Identifying information including:
1. The family name(s), address(es), and
telephone number(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 (l), 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 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 any disclosures of information that includes:
(1) The information disclosed;
(2) The date of disclosure; and
(3) The name of the recipient of the information.
(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 insuring the
confidentiality of any personally identifiable information.
(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 reasonable 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 and advise the parent of the right to
complain pursuant to He-M 203.
(p) If, as a result
of complaint resolution pursuant to He-M 203, it is decided 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 complaint resolution, it is decided 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 may 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)
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) – (i) 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) 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 (i) 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.
(h) An FCESS program
shall not require a parent to sign up for or enroll in Medicaid as a condition
of receiving FCESS.
(i) 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.
Source. #9594, eff 11-11-09 (from He-M 510.11); ss by
#10325, eff 4-26-13 (from He-M 510.15)
He-M 510.15 Interagency
Coordinating Council. The purpose of
the interagency coordinating council shall be to provide advice to the bureau
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)
He-M 510.16 Central
Directory.
(a) The purpose of
the central directory shall be to provide information about:
(1) Public and private FCESS, 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)
He-M 510.17 Waivers.
(a) An area agency,
ESS 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” (September 2013 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 his or her 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)
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
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:
a. Significant decline in cognitive functioning
and ability; and/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 and designated by the commissioner of the department of health
and human services to provide services to persons with developmental
disabilities or acquired brain disorders in accordance with RSA 171-A:18 and
He-M 505.
(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 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 services and supports 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 handicap 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 services or supports 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
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 (e);
(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
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)
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. Perform a criminal records check in
1. Felony conviction; or
2. Any misdemeanor conviction involving:
(i) Physical or sexual assault;
(ii) Violence;
(iii) Exploitation;
(iv) Child pornography;
(v) Threatening or reckless conduct;
(vi) Driving under the influence of drugs or
alcohol;
(vii) Theft; or
(viii) Any other conduct that represents evidence of
behavior that could endanger the well-being of an individual.
(e) For agency-arranged respite services, an applicant
shall be denied employment who:
(1) Has a criminal record as listed in (d)(3)b.
above;
(2) Is listed on the registry pursuant to RSA
161-F:49; or
(3) Refuses to consent to checks pursuant to
(d)(3) above.
(f)
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.
(g)
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.
(h)
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 (n) 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.
(i)
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),
(g), and (h) above.
(j) 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.
(k)
Training identified in (j) above shall not apply if the respite service
provider’s experience or education has included such training or the respite
service provider has, in the judgment of the area agency and the family,
sufficient skills to provide respite services for a specific individual.
(l)
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.
(m)
The area agency shall maintain a file on each respite service provider
that includes:
(1) Items and documentation described under
(c)-(g) and (l) 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 (o)-(p) below, of each service
provided, or cross‑references to individuals’ files where such
evaluations are located.
(n)
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 is
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.
(o)
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.
(p)
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 (n) 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
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
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
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
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” (September 2013
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 forms 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 a period that shall not exceed 5
years from the date the waiver was granted.
(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
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
(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
(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
(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
105 Pleasant
Street,
(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
(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,
eff8-22-05 (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,
eff8-22-05 (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,
eff8-22-05 (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,
eff8-22-05 (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
(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
(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
105
Pleasant Street,
(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
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 an entity established as a non-profit corporation in
the state of New Hampshire and designated by the commissioner to provide
services to persons with developmental disabilities or acquired brain disorders
in the area in accordance with RSA 171-A:18 and He-M 505.
(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)
“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 intellectually disabled individuals; 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.”
(g)
“Family” means a group of 2 or more persons that:
(1) Is related by ancestry, marriage, 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 (i) below.
(h)
“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.
(i) “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.
(j) "Region" means a
geographic area designated pursuant to He-M 505.04 for the purpose of providing
services to persons with developmental disabilities or acquired brain disorders
and their families.
(k)
“Respite” means the provision of short-term and periodic services for an
individual, in or out of the family home, for the support of the family with
whom the individual lives.
(l)
“Service agreement” means a written agreement between a family and an
area agency that describes the services that the family will receive.
(m)
“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
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
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 be comprised of supports and services such as:
(1) Information and referral;
(2) Identification of, and assistance to access,
community resources and supports;
(3) Assistance with transition in and out of
services;
(4) Crisis intervention and emotional support;
(5) Advocacy for accessing supports and services;
(6) Family networking;
(7) Accessing respite care;
(8) Accessing environmental modifications of the
family’s home and the family’s vehicle;
(9) Promotion of inclusive social and
recreational opportunities;
(10) Conferences and workshops in response to
families’ requests;
(11) Community outreach, education, and
development to promote understanding and support for families as well as
individuals with disabilities;
(12) Financial
assistance, as available, in the form of cash subsidies, vouchers, or
reimbursements 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
(13) 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
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 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, rotation, and term limits on the
council;
(2) A process for determining the chairperson,
the state council delegate, and any other positions such as the council
representative to the area agency board of directors;
(3) Orientation and mentoring of all council
members;
(4) A formal 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; and
d.
The family support representative on the area agency management team and the
mechanism for direct communication between this person and the council;
(5) Processes used to disperse family support
council funds and other resources; 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, including early supports and services
providers, that serve children and their families.
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
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; and
(5) 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 service agreements with each
family that document the supports in He-M 519.04 (c) that will be provided;
(4) Maintain data that specifies the type and
frequency of family supports and services provided; and
(5) Report data collected pursuant to (4) 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
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
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 bureau administrator and bureau 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
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.
(b) The
entity requesting a waiver shall:
(1) Complete the form
entitled “NH Bureau of Developmental Services Waiver Request” (September 2013
edition); and
(2) 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)
All information entered on the forms 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 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.
(i) An
area agency or regional family support council 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 (e) 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))
PART
He-M 520 CHILDREN’S SPECIAL MEDICAL
SERVICES
Statutory Authority: RSA 132:10-b, IV
He-M 520.01 Definitions.
(a)
“Administrator” means the person who oversees the special medical
services (SMS) section of the bureau of developmental 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, commissions before
deductions;
b. Net earnings or Schedule C 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 developmental 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
(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) No
more costly 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, 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 administrative section of the
bureau of developmental 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 an 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
(ac)
“Title XXI” means the joint federal-state program described in Title XXI
of the Social Security Act and administered in
Source. #9748-A, eff 7-1-10; amd by #10138, eff
7-1-12
He-M
520.02 Application Procedure.
(a) Except for applicants under (i) below, and in
order to be determined eligible to receive program services or financial
assistance, a signed, dated, and completed application, entitled “Special
Medical Services (SMS) – Application for All Services,” (November 2012) 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 520.05; and
(2) Notify the applicant in writing of the
applicant’s eligibility status and the services for which the applicant is
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) For those applicants applying for services
through an SMS sponsored child development clinic, the following shall apply:
(1) The requirements in (a) – (j) above shall not
apply;
(2) A completed “SMS Short Application” (July
2012) shall be submitted to SMS;
(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, shall be submitted to SMS;
(4) Eligibility shall be effective for 12 months
after the application is submitted; and
(5) To maintain eligibility, another application
shall be submitted to SMS.
(j) 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
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
(c)
Be, or have a parent or guardian who is, a
(d)
Be under the age of 21.
Source. #9748-A, eff 7-1-10
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 Title XIX
and other types of third-party assistance;
(2) SMS
psychological and psychiatric consultation services;
(3) SMS
nutrition services;
(4) SMS
feeding and swallowing services;
(5) SMS
specialty services provided through attendance at child development clinics
sponsored by SMS; and
(6) SMS
specialty services provided through attendance at neuromotor clinics sponsored
by SMS.
(b)
A recipient shall be limited to the services listed in (a)(3)-(5) 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
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;
(2) Are
married; or
(3) Have
their own children.
(h)
For a child residing with a parent and one or more unrelated adults, 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
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:
(i) Not more than 12 months prior to the
submission date;
(ii) Not prior to the recipient’s application
date; and
(iii) 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;
(3) The
service is identified in the recipient’s SMS health care plan; or
(4) 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
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
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
He-M 520.09 Waivers.
(a)
An applicant, parent, or guardian may request a waiver of specific
services as outlined in He-M 520 using the form titled “NH Special Medical
Services, services waiver (July 2010)”.
(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,
(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
PART
He-M 521 CERTIFICATION OF RESIDENTIAL
SERVICES, COMBINED RESIDENTIAL AND DAY SERVICES, OR SELF-DIRECTED DAY 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 day 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
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;
(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:
a. Significant decline in cognitive functioning
and ability; and/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, 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) “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) “Day services” means services that include
supports for individuals to participate in community activities such as
volunteer work, paid employment, or recreation.
(g) “Department” means the department of health
and human services.
(h) “Developmental
disability” means “developmental disability” as defined under RSA 171-A:2, V.
(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 the parent of an individual under
the age of 18 whose parental rights have not been terminated or limited by law.
(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) “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.
(n) “Service” means
any paid assistance to an individual provided through the area agency.
(o) “Service
agreement” means a written agreement between an individual or guardian and an
area agency that describes the services that an individual will receive and
constitutes an individual service plan as defined in RSA 171-A.
(p) “Service
coordinator” means a person who is:
(1) Chosen or approved by an individual and, if
applicable, his or her representative;
(2) 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
(3) Any one of the following:
a. An area agency service coordinator, family
support coordinator, or any other area agency or subcontract agency;
b. A member of the individual’s family;
c. A friend of the individual; or
d. Any other person chosen by the individual.
(q) “Staff” means a
person employed by an area agency or subcontract agency.
(r) “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.
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
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
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
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, 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 subcontract agency shall, in
consultation with the individual, guardian, and family, develop a contract
that:
(1)
Identifies the responsibilities of the area agency, subcontract
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 subcontract 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 506.03,
He-M506.05 (a)-(c), and He-M 521.06.
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
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 or subcontract agency staff, or home providers;
(b) Comply with Nur 404 when a nurse identified
in Nur 404.03 delegates the task of medication administration to providers who
are neither family members nor under contract with an area agency or
subcontract 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 subcontract 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
He-M 521.07 Quality Assessment. An area agency shall monitor services
provided pursuant to He-M 521 as follows:
(a)
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;
(b)
The service coordinator or a designated area agency staff shall visit
the individual at home 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 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
(c)
If applicable, a prescribing practitioner or registered nurse shall
review medication administration related activities according to He-M 1201.08
(b)(1) at least semi-annually.
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
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 day 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
He-M 521.09 Certification.
(a)
Residential services and combined residential and day 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
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
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, subcontract 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, 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
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 subcontract 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;
(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, 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
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, subcontract 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
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, 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. #7494, eff 5-22-01; ss by #9475, eff 5-22-09
He-M 521.12 Appeals.
(a)
Pursuant to He-M 202, 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. 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 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
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 form HCFA 837 to:
Professional
Claims
EDS
Corporation
(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:
Department
of Health and Human Services
Bureau
of Developmental Services
State
Office Park South
105
Pleasant Street
(e)
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.
(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
He-M 521.14 Waivers.
(a)
An area agency, subcontract agency, individual, representative, or
provider may request a waiver of specific procedures outlined in He-M 521 using
the form titled “NH bureau of developmental services waiver request.” 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(s) or guardian(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
105
Pleasant Street,
(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 area agency’s,
subcontract agency’s, individual’s, representative’s, or provider’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 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.
Source. #9475, eff 5-22-09 (from He-M 521.12)
PART He-M 522 ELIGIBILITY DETERMINATION AND SERVICE
PLANNING 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 decision-making authority of persons with acquired
brain disorder, and
promote each 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
He-M 522.02 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:
a. Significant decline in cognitive functioning and ability; and/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 that
is authorized by the bureau pursuant to He-M 522.15 (n) when funds are not
otherwise available for an individual who is in crisis and needs services
immediately.
(c) “Applicant” means any person with an acquired
brain disorder, or such person’s guardian, who requests services pursuant to
He-M 522.04.
(d) “Area agency” means 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 persons with acquired
brain disorders in the area.
(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) “Bureau” means
the bureau of developmental services of the department of health and human
services.
(g) “Bureau administrator” means the chief
administrator of the bureau of developmental services.
(h) “Commissioner”
means the commissioner of the department of health and human services.
(i) 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.
(j) “Consolidated
services” means a service arrangement whereby the individual or representative
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 opportunities and experiences in living, working, socializing,
and recreating. It does not include
financial arrangements whereby all the budgeted funds are designated to a
congregate living arrangement or program.
(k) “Department” means the department of health
and human services.
(l) “Developmental
disability” means “developmental disability” as defined under 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.”
(m) “Guardian” means a person appointed pursuant
to RSA 463 or RSA 464-A or who is a parent of an individual under the age of 18
who is not an emancipated minor.
(n) “Individual” means a person with an acquired
brain disorder who is eligible to receive services pursuant to He-M 522.03.
(o) "Informed consent" means a decision
made voluntarily by an individual or applicant for services or, where
appropriate, such person's legal guardian, 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.
(p) “Medicaid home- and community-based care
services” means services provided in accordance to He-M 517.
(q) “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, Fourth Edition, Text Revision (DSM-IV-TR), July 2000:
(1) Schizophrenia and other
psychotic disorders;
(2) Mood disorders;
(3) Borderline personality
disorder;
(4) Post traumatic stress
disorder;
(5) Obsessive compulsive disorder;
(6) Eating disorder;
(7) Dementia, where the
psychiatric symptoms cause the functional impairments and one or more of the
following co-morbid symptoms exist:
a. Anxiety;
b. Depression;
c. Delusions;
d. Hallucinations; and
e. Paranoia; and
(8) Panic disorder.
(r) “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 regarding 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, if applicable, the 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 or
guardian, as applicable, prefers not to have this included in the profile.
(s) “Provider” means a person receiving any form
of remuneration for the provision of services to an individual.
(t) “Provider
agency” means an area agency or another entity under contract with an area
agency to provide services.
(u) “Region” means a geographic area established
by He-M 505.04 for the purpose of providing services to developmentally
disabled persons and that provides services to persons with acquired brain
disorder.
(v) “Service” means
any paid assistance to the individual in meeting his or her own needs provided
through the area agency.
(w) “Service
agreement” means a written agreement between the individual or guardian and the
area agency that describes the services that an individual will receive.
(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, 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) “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.
(z) “Supports
Intensity Scale” means a
nationally recognized assessment tool published by the American Association on Intellectual
and Developmental Disabilities that evaluates practical support requirements of
a person with an intellectual disability or acquired brain disorder.
(aa) “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.
(ab) “Vacancy” means funds that become available
when an individual stops receiving acquired brain disorder services.
(ac) “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
He-M 522.03 Eligibility for Services.
(a) Any resident of
(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 503.10.
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
He-M 522.04 Application for Services.
(a) Application for services shall be made by an
applicant or an applicant’s guardian.
(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 or guardian in making application
for services.
(d) The area agency shall inform the applicant or
guardian of its roles and responsibilities and provide information about:
(1) Evaluation;
(2) Eligibility determination;
(3) Service coordination;
(4) Service agreement development
and review;
(5) Services provided by the area
agency and how service needs are identified;
(6) Service provision; and
(7) Service monitoring.
(e) An area agency shall request each applicant
to authorize release of information to permit the area agency to access
relevant records and information regarding the applicant’s:
(1) Acquired brain disorder;
(2) Personal, family, social,
educational, neuropsychological, medical and rehabilitation history; 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 an assessment 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
He-M 522.05 Determination of Eligibility as a Person
with an Acquired Brain Disorder.
(a) The area agency
shall determine if an applicant is eligible for services under He-M 522.03 (a)
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) Within 15 business days after the receipt of
the application, the area agency shall review the information it has obtained
regarding an applicant and make a decision on the applicant’s eligibility. If the information required to determine
eligibility cannot be obtained within the 15 business day period, the area
agency shall request an extension from the applicant or guardian, state the
reason for the delay, and obtain approval from the applicant or guardian in
writing. This extension shall not exceed
30 business days after the receipt of application.
(c) In cases where the information on eligibility
under He-M 522.03 (a) is inconclusive, the area agency may consult the bureau
regarding determination of eligibility.
If it is anticipated that eligibility will not be determined within the
15 business day period stated in (b) above, the area agency shall request an
extension from the applicant or guardian, state the reason for the delay and,
if the applicant or guardian approves, obtain such approval from the applicant
or guardian in writing. This extension
shall not exceed 30 business days after the receipt of application.
(d) If the area agency request for an extension
pursuant to (b) or (c) above is denied by the applicant or guardian, the area
agency shall determine the applicant to be ineligible for services and shall
notify the applicant of the right to appeal as identified in He-M 522.19. The individual or guardian may reapply for
services pursuant to (i) below.
(e) An area agency may determine an applicant
eligible for services pursuant to He-M 522.03 (a) prior to the receipt of all
components of an applicant’s evaluation if there is sufficient information to
make this determination. The area agency
shall continue to pursue all components of the evaluation, which shall be
completed within 30 business days of application and shall be kept in permanent
files established for each applicant.
(f) The area agency director shall authorize
appropriate 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 whom the area agency director believes is likely to have
an acquired brain disorder, based upon available information.
(g) For an applicant found ineligible under He-M
522.03 (a), within 3 business days of determination, the area agency shall
provide the applicant or guardian a written decision that describes the
specific legal and factual basis for the denial, including specific citation of
the applicable law or department rules, and advise the applicant in writing and
verbally of the appeal rights under He-M 522.19.
(h) For an applicant found eligible under He-M
522.03 (a), within 3 business days the area agency shall:
(1) Make a written referral to the
bureau 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 bureau
for eligibility determination under He-M 522.06 (a).
(i) Following denial
of eligibility, the individual, family, 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.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff 10-6-07, EXPIRED: 4-3-08
New.
#9734, eff 6-25-10
He-M 522.06 Determination of Eligibility for
(a) For those persons found eligible under He-M
522.03 (a), the bureau 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 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
bureau’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 522.19.
(c) Following denial of eligibility, the
individual, family, 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 accepted by 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
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 guardian if the
individual has one, and arrange for a reassessment of eligibility. The individual 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 bureau
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 or guardian in
writing of the determination and phase out the relevant services over the 12
months following the redetermination.
(c) Written notification to the person or
guardian shall include the basis of the reason(s) for redetermination,
including specific citation of the applicable law or department rule, 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 and
advocacy organizations, such as the New Hampshire Disabilities Rights Center,
that the individual or guardian may contact for assistance in appealing the
decision.
(d) A person or guardian may appeal a denial of
eligibility based on redetermination pursuant to He-M 522.19 or He-M 517.09.
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)
He-M 522.08 Preliminary Recommendations for Services.
(a) For those
applicants eligible for service coordination and community support under He-M
522.03 (a), within 5 business days of notification of eligibility the area
agency shall:
(1) Designate an interim service coordinator to
hold a planning session regarding the provision of services identified in He-M
522.10 (b); and
(2) Inform the individual verbally and in writing
of his or her right to choose or approve a service coordinator in accordance
with He-M 522.10 (a).
(b) For those applicants eligible for Medicaid
home- and community-based care services under He-M 522.03 (b), within 5
business days of notification of eligibility the area agency shall:
(1) Designate an interim service coordinator to
develop a service agreement with the individual in accordance with He-M 522.11
and He-M 522.12;
(2) Inform the individual verbally and in writing
of his or her right to choose or approve a service coordinator in accordance
with He-M 522.10 (a);
(3) Based on information obtained
pursuant to He-M 522.05 (a), conduct sufficient preliminary planning with the
individual and guardian, either at the time of intake or during subsequent
discussions, to identify and document the specific services needed and the date
on which services will begin; and
(4) Request funding for services
from the bureau.
(c) To the extent
that funds for this purpose are available and appropriated to the bureau by the
Legislature and except as provided in He-M 522.15 (a), the bureau shall fund
services within 90 days of completion of the preliminary planning required by
(b)(3) above or within 90 days of the start date requested by the individual or
guardian, whichever is later.
(d) If funding for the individual is not
available but the individual needs and is ready to receive services currently,
the area agency shall:
(1) Place the individual’s name on
the wait list in accordance with He-M 522.15 (e);
(2) Review available resources to provide partial
assistance to the individual on an interim basis whenever possible;
(3) Assist the individual to access supports from
sources external to the area agency; and
(4) Contact the individual or guardian quarterly
to update information and document such contact.
(e) If the individual does not need services
currently, but will during the current or following fiscal year, the area
agency shall:
(1) Place the individual’s name on the projected
service needs list in accordance with He-M 522.15 (f); and
(2) Contact the individual or
guardian quarterly to update information and document such contact.
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)
He-M 522.09 Service Guarantees on Services for Which
Funds Are Available.
(a) All services shall:
(1) Be voluntary on the part of
the individual;
(2) Be provided only after the
informed consent of the individual or guardian;
(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, adult education, and leisure activities;
(3) Promote the individual’s
health and safety;
(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; and
(9) Be provided in such a way that
the individual is seen as a valued, contributing member of his or her
community.
(c) The environment in which an individual
receives services shall promote the person’s freedom of movement, ability to
make informed decisions, self-determination, and participation in the
community.
(d) An individual or guardian may select any
person, any 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 advise the individual
and guardian verbally and in writing prior to the initial and yearly individual
service agreement planning process under He-M 522.11 and He-M 522.12 that he or
she has a right to choose his or her own provider(s). The area agency shall provide a state-wide
list of service providers to individuals and guardians who wish to choose
providers.
(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, and proposed or current provider, if the area agency determines that
a provider chosen by the individual or guardian is a provider that proposes a
service arrangement that 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 or guardian stating the reasons why the area agency will not
enter into a service contract with the provider; and
(2) With input from the individual
or guardian, identify another provider.
(g) After discussions with the individual,
guardian, and proposed or current provider, if the area agency determines that
a provider chosen by the individual or guardian is not implementing the service
agreement, providing for the health and safety of the individual, or in
complying 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
or guardian, establish another service arrangement and amend the service
agreement.
(h) If the area agency determines that a provider
chosen by the individual or guardian is posing a serious threat to the health
or safety of the individual, the area agency shall, with input from the
individual or guardian, 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 or guardian may appeal the
area agency’s decision under (f)–(h),
above. At the time it provides
notice, the area agency shall advise the individual or guardian in writing and
verbally of his or her appeal rights under He-M 522.19.
(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 522.08)
He-M 522.10 Service Coordination.
(a) The service coordinator shall be a person
chosen or approved by the individual or guardian and approved by the area
agency pursuant to paragraph (d) below, provided that the area agency shall
retain ultimate responsibility for service coordination. The area agency shall advise the individual
and guardian verbally and in writing prior to the preliminary planning stage
under He-M 522.08 and prior to the initial and yearly individual service
agreement planning process under He-M 522.11 and He-M 522.12 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.
(b) 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.
(c) 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 522.09 (b);
(2) Coordinate the service
planning process in accordance with He-M 522.09 and He-M 522.11;
(3) Describe to the individual or
guardian service provision options such as consolidated services;
(4) Monitor and document services
provided to the individual;
(5) Ensure the continuity and
quality of services provided;
(6) Ensure that service
documentation is maintained pursuant to He-M 522.12 (d)(1) and (g)(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 or guardian 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;
or
d. There is a need for a new
provider; and
(9) Document service coordination
visits and contacts pursuant to He-M 522.11 (j) and He-M 522.12 (g) (2)-(4).
(d) A service coordinator shall not:
(1) Be a guardian 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.
(e) If the service coordinator chosen by the
individual or guardian is not employed by the area agency or its subcontractor
the following requirements shall apply:
(1) The service coordinator and
area agency shall enter into an agreement that describes:
a. The role(s) set forth in He-M
522.10 for which the service coordinator assumes responsibility;
b. The reimbursement, if any,
provided by the area agency to the service coordinator; and
c. The oversight activities to be
provided by the area agency;
(2) If the area agency determines
that the service coordinator is not ensuring the implementation of the service
agreement 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 or guardian, pursuant to He-M
522.10 (a); and
(3) If the area agency determines
that a service coordinator chosen by the individual or guardian is posing a
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 or guardian, pursuant to
He-M 522.10 (a).
(f) For individuals who receive both acquired
brain disorder services and behavioral health services, 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 (b).
(g) 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.
(h) The individual or guardian may appeal the
area agency’s decision under (e) (2) or (3) above pursuant to He-M 522.19. At the time it provides notice under (e) (2)
or (3) above, the area agency shall advise the individual or guardian verbally
and in writing of his or her appeal rights under He-M 522.19.
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)
He-M 522.11 Service Planning for Individuals Eligible
for Medicaid Home- and Community-based Care Services.
(a) Once funding is identified for an individual,
the service coordinator shall facilitate service planning to develop a service
agreement in accordance with He-M 522.12.
(b) The service planning shall:
(1) Be a personalized and ongoing
process to plan, develop, review, and evaluate the individual’s services in
accordance with the criteria set forth in He-M 522.09;
(2) Include identification by the
individual or guardian and the individual’s service providers of those services
and environments that will promote the individual’s health, welfare, and
quality of life; and
(3) Include information obtained through
utilization of the Supports Intensity Scale (SIS), which shall be administered
for each individual:
a. Upon
determination of the individual’s eligibility; and
b. Either:
1. Every 5 years thereafter; or
2. When there is a significant
life change in the individual’s status or condition, as described in He-M
522.15 (l).
(c) The service coordinator shall, as applicable,
maximize the extent to which an individual participates in and directs his or
her service planning process by:
(1) Explaining to the individual
the service planning process and assisting the individual to determine the
process within the scope of He-M 522;
(2) Explaining to the individual
his or her rights and responsibilities;
(3) 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;
(4) Determining with the
individual issues to be discussed during 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.
(d) The individual or guardian 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; and
(4) Topics to be discussed.
(e) In order to develop or revise a service
agreement to the satisfaction of the individual or guardian, the service
planning process shall consist of periodic and ongoing discussions and meetings
that:
(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.
(f) The service planning process shall include a
discussion of the need for guardianship.
The area agency director shall implement any recommendations concerning
guardianship contained in the service agreement.
(g) The service planning process shall include a
discussion of the need for assistive technology that could be utilized to
support any services or activities identified in the proposed service agreement
regardless of the individual’s current use of assistive technology.
(h) Service agreements shall be reviewed by the service
coordinator with the individual or guardian at least once during the first 6
months of service and, thereafter, as needed.
The annual review required by He-M 522.10 (b)(8) shall include a service
planning meeting.
(i) The individual or guardian may request, in
writing, a delay in an initial or annual service agreement meeting. The area agency shall honor this request.
(j) The service coordinator shall be responsible
for monitoring services identified in the service agreement and for assessing
individual, family, or guardian satisfaction at least annually for basic
service agreements and quarterly for service agreements.
(k) An area agency director, service coordinator,
service provider, individual, guardian, or individual’s friend shall have the
authority to request a service agreement 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;
(4) The individual has experienced
a significant life change; or
(5) A service agreement is not
being carried out in accordance with its terms.
(l) At a meeting held pursuant to (k) above, the
participants shall:
(1) Document whether and how to
modify the service agreement; and
(2) Identify any service needs,
including those due to a significant life change, that are not currently
funded.
(m) Service agreement amendments may be proposed
at any time. Any amendment shall be made
with the consent of the individual or guardian and the area agency.
(n) Service agreement amendments made as a result
of a significant life change shall be implemented with the individual’s or
guardian’s written approval except by mutual agreement between the area agency
and the individual specifying a time limited extension.
(o) If the individual, guardian, or area agency
director disapproves of the service agreement, the dispute shall be resolved by
one or more of the following:
(1) Informal discussions between
the individual or guardian and service coordinator;
(2) Reconvening a service planning
meeting; or
(3) The individual or guardian
filing an appeal to the bureau 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
He-M 522.12 Service Agreements for Individuals
Eligible for
(a) The service coordinator shall convene a
meeting to prepare a service agreement in accordance with (b)–(f) below within
20 business days of the determination that funding for services for an
individual.
(b) 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.
(c) Copies of relevant evaluations and reports
shall be sent to the individual and guardian at least 5 business days before
service planning meetings.
(d) Within 10 business days following a service
planning meeting pursuant to (a) above, the service coordinator shall:
(1) Prepare a written service
agreement that:
a. Includes the following:
1. A personal profile; and
2. A list of those who
participated in the service planning agreement meeting; and
b. Describes the following:
1. The specific support services
to be provided under each service category;
2. The goals to be addressed, and
timelines and methods for achieving them;
3. The persons responsible for
implementing the service agreement;
4. Services needed but not
currently available;
5. 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;
6. Service documentation
requirements sufficient to describe progress on goals and the services
received;
7. If applicable, reporting
mechanisms under self-directed services regarding budget updates and individual
and guardian satisfaction with services; and
8. 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 and confirm that they are to the
individual’s and guardian’s satisfaction.
(e) Within 5 business days of completion of the service
agreement, the area agency shall send the individual or guardian the following:
(1) A copy of the 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 service agreement pursuant to He-M
522.19 for those situations where the individual or guardian disapproves of the
service agreement.
(f) The individual or guardian shall have 10
business days from the date of receipt of the service agreement to respond in
writing, indicating approval or disapproval of the service agreement. Unless otherwise arranged between the
individual or guardian and the area agency, failure to respond within the time
allowed shall constitute approval of the service agreement.
(g) When a service agreement has been approved by
the individual or guardian and area agency director, the services shall be
implemented and monitored as follows:
(1) A person responsible for
implementing any part of a 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 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
service agreement; and
(4) If the individual receives
services under He-M 1001, He-M 521, or other residential licenses under RSA
151:2, I (e), at least 2 of the service coordinator’s quarterly visits with the
individual shall be in the home where the individual resides.
(h) The service coordinator and a licensed nurse
shall visit the individual within 5 days of relocation to a new residence or
change in a residential provider to:
(1) Determine if the transition
has resulted in adverse changes in the health or behavioral status of the
individual; and
(2) Develop and document a plan
to remediate any issues, if negative changes are noted.
(i) Service agreements shall be renewed at least
annually.
Source. #7120, eff 10-20-99; ss by #8974, INTERIM,
eff 10-6-07, EXPIRED: 4-3-08
New.
#9734, eff 6-25-10
He-M 522.13 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 (f) 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. The name, address, and
telephone number of the legal guardian or next of kin or
other person to be notified;
b. The names, addresses, and
telephone numbers of current service providers;
c. Medical information, including
the individual’s:
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) 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;
(5) Other correspondence or
memoranda concerning any significant events in the individual’s life; and
(6) Information about transfer or
termination of services, as appropriate.
(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 bureau 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 522.12 (g)
(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
He-M 522.14 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 (f) 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. The name, address, and
telephone number of the legal guardian or next of kin or
other person to be notified;
b. The names, addresses, and
telephone numbers of current service providers; and
c. Medical information, including
the individual’s:
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 provider
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 other 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 and 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 bureau 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
He-M 522.15 Allocation of Funds for Current and Future
Individual Service Requests.
(a) All services covered by He-M 522 shall be
provided to the extent that funds for this purpose are available and
appropriated to the bureau by the Legislature.
(b) For each applicant found eligible for Medicaid
home- and community-based services, the area agency shall seek funding upon
completion of the preliminary recommendation process pursuant to He-M 522.08.
Unless the area agency makes a request for advanced crisis funding pursuant to
(k)-(m) below, the bureau, subject to He-M 522.15 (a), shall allocate funding
within 90 days of the preliminary service recommendation or within 90 days of
start date requested by the individual or guardian, whichever is later.
(c) For individuals who are already receiving
Medicaid home- and community-based care services, if additional services are
needed, the area agency shall request such funding and, subject to He-M 522.15
(a), the bureau shall approve it within 90 days of amendment of the individual
service agreement or within 90 days of the start date requested by the
individual, whichever is later, unless the area agency makes a request for
advanced crisis funding pursuant to (k)-(m) below.
(d) Each area agency shall
maintain a projected service needs list for:
(1) Individuals who:
a. Are newly eligible;
b. Do not require services
currently; and
c. Will need services later within
the current or following fiscal years; and
(2) Individuals who:
a. Are receiving services; and
b. Will need additional services
later within the current or following fiscal years.
(e) Each area agency shall maintain a wait list
for those individuals for whom funding is not available in accordance with (a)
above and who:
(1) Do not qualify for services
under (k)-(m) below; and
(2) Either:
a. Do not receive services but
need and are ready to receive services; or
b. Currently receive services and
need and are ready to utilize additional services.
(f) Each area agency shall include the following
information on its wait list and projected service needs list:
(1) The name and date of birth of
the individual;
(2) The diagnosis that identifies
the individual’s acquired brain disorder;
(3) A brief description of the
individual’s circumstances and the services he or she needs;
(4) The type and amount of
services received, if any;
(5) A preliminary estimate of
cost;
(6) The date by which services are
needed; and
(7) The date the individual’s name
went on the wait list or projected service needs list.
(g) Each area agency shall report
to the bureau quarterly:
(1) On the wait list pursuant to
(e) above; and
(2) On the projected service needs
list pursuant to (d) above.
(h) To access the wait list funds appropriated
for a given fiscal year, the area agency shall submit to the bureau a single
list with the names of:
(1) All individuals on its wait
list; and
(2) Those individuals on the
projected service needs list who will be ready to receive services in that
fiscal year.
(i) In submitting its list pursuant to (h) above,
the area agency shall prioritize each individual’s standing on the list by
determining the individual’s urgency of need based on the following factors:
(1) Current type or level of
services does not provide the assistance and environment to meet all the
individual’s needs;
(2) Declining health of the
caregiver;
(3) Declining health of the
individual;
(4) Individual with no day
services while living with a caregiver;
(5) Individual’s low safety
awareness;
(6) Individual’s behavioral
challenges;
(7) Individual’s involvement in
the legal system;
(8) Individual living in or at
risk of going to an institutional setting;
(9) Significant regression in
individual’s overall skills such that the individual’s level of independence is
diminished; and
(10) Length of time on the wait
list as compared to others.
(j)
In maintaining its wait list and projected service needs list, 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.
(k)
For individuals eligible for Medicaid home- and community-based care
services or currently receiving such services, an area agency shall request
advanced crisis funding to provide services without delay when there are no
generic or area agency resources available and an individual is experiencing a
significant life change pursuant to (l) below.
(l) An individual shall be considered to be
experiencing a significant life change if he or she is:
(1) A victim of abuse or neglect
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; or
(5) Presenting a significant risk
to his or her own or the community’s safety due to involvement with the legal
system.
(m) To demonstrate the need for advanced crisis
funding, the area agency shall submit to the bureau, in writing, a detailed
description of the individual’s circumstances and needs and a proposed budget.
(n) The bureau shall review the information
submitted by the area agency and approve advanced crisis funding if it
determines that one of the conditions cited in (l) above applies to the
individual’s situation.
(o) For each request an area agency makes for
funding individual services, the bureau 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
He-M 522.16 Transfers Across Regions.
(a) If an individual plans to relocate residency
to another region and wishes to transfer his or her area agency affiliation to
that region, the individual or guardian shall notify in writing the area agency
in the current region and the area agency in the proposed region that he or she
is moving and wishes to transfer services.
(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 (from He-M 522.12)
He-M 522.17 Termination of Services.
(a) Any person may make a recommendation for
termination of service(s) to an individual.
Any such recommendation shall be made in writing to the area agency
director.
(b) If termination of services is being
considered, the service coordinator shall meet with the individual or guardian,
or both, to discuss the reasons for the recommended termination.
(c) A recommendation for termination shall be
based on any of the following:
(1) The individual does not
require such service(s);
(2) Services are no longer
necessary because they have been replaced by other supports or services; or
(3) The individual no longer meets
eligibility under He-M 522.03 or He-M 517.03.
(d) 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, the individual or guardian, or both, and
the service provider(s) to be convened to review the request. The purpose of the meeting shall be to
determine if any of the criteria listed in (c) above apply to the individual.
(e) Based on the information presented and
determinations made at the meeting, the service coordinator shall prepare a
written report for the area agency director that 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.
(f) The area agency director shall make the final
decision regarding termination based on the criteria listed in (c) above.
(g) If a decision is made to terminate services
pursuant to (f) above, the area agency director shall, within 30 days of the
decision, send a termination notice to the individual or guardian outlining a
12 month phase out period. Service may
be terminated sooner with the consent of the individual or guardian. The individual or guardian may appeal the
termination decision in accordance with He-C 200.
(h) 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 New Hampshire Disabilities Rights Center,
which the individual or guardian may contact for assistance in appealing the
decision.
(i) 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 or guardian, in writing, to the area agency director.
(j) Upon request of the individual or guardian,
the area agency director shall resume services to an individual whose services
have been terminated if the criteria in (c) above no longer apply, to the
extent that funds for this purpose are available and appropriated to the bureau
by the Legislature.
(k) Individuals who have been terminated pursuant
to (c)(3) above and request resumption of services shall reapply in accordance
with He-M 522.04.
Source. #9734, eff 6-25-10 (from He-M 522.13)
He-M 522.18 Voluntary Withdrawal from Services.
(a) An individual or guardian may withdraw
voluntarily from any service(s) at any time.
(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, 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 and
his or her service coordinator or any other person believes that the individual
is not able to make 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 or guardian, in writing,
to the area agency director.
(f) Upon request of the individual or guardian,
the area agency director shall resume services to the individual to the extent
that funds for this purpose are available and appropriated to the bureau by the
Legislature. If there is reason to
believe that the individual’s eligibility status has changed, the area agency
shall request a reapplication pursuant to He-M 522.03.
Source. #9734, eff 6-25-10 (from He-M 522.14)
He-M 522.19 Challenges and 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. Any determination,
action, or inaction by an area agency may be appealed by an individual or
guardian.
(b) The following actions shall be subject to the
notification requirements of (c) below:
(1) Adverse eligibility actions
under He-M 522.05 (g), He-M 522.06 (b), and He-M 522.07 (b);
(2) Area agency determinations
regarding an individual’s or guardian’s selection of provider under He-M 522.09
(f) or removal of provider under He-M 522.09 (g) and (h);
(3) Area agency determinations
regarding the removal of an individual or guardian’s selected service
coordinator under He-M 522.10 (e) (2) and (3); or
(4) A determination to terminate
services under He-M 522.17 (f).
(c) An area agency
shall provide written and verbal notice to the applicant and guardian of the
actions specified in (b) 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 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; 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
(d) 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.
(e) 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.
(f) 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:
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 522.15)
He-M 522.20 Waivers.
(a) An area agency, provider agency, or individual
may request a waiver of specific procedures outlined in He-M 522 using the form
titled “NH bureau of developmental services waiver request.”
(b) A completed waiver request form shall be
signed by:
(1) The individual(s) or legal guardian(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
105 Pleasant Street,
(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 provider agency 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 area agency’s, provider agency’s, or individual'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 area agency, provider agency, or
individual 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 522.16)
PART He-M 523 FAMILY SUPPORT SERVICES TO CHILDREN AND YOUNG
ADULTS WITH CHRONIC HEALTH CONDITIONS
Statutory
Authority: RSA 161:4-a, IX
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
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)
“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)
“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. Significantly 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 frequent and 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).
(e)
“Department” means the
(f)
“Family” means the biological, adoptive, or foster parents or legal
guardians of a child aged 0 to 21 who has a chronic health condition.
(g)
“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.
(h)
“Lead agency” means an entity awarded a contract by special medical
services (SMS) to provide Partners in Health services to young adults and
families living in a designated region.
(i)
“Partners in Health (PIH)” means a
(j)
“Special medical services (SMS)” means the administrative section of the
bureau of developmental services that supervises Partners In Health.
(k)
“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 to 21 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
He-M 523.03 Eligibility.
(a)
An applicant shall be eligible for services described in He-M 523.05 if
the applicant is a family as defined in He-M 523.02(f) or a young adult as
defined in He-M 523.02(k).
(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(d).
(c) An applicant who meets the criteria of a
chronic health condition as defined in He-M 523.02(d) 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 receives services pursuant to He-M
503.07 through He-M 503.11;
(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) If an individual has a developmental
disability, and he or she is receiving services pursuant to He-M 503.07 through
He-M 503.11, that individual shall not receive services under He-M 523.
(e) A young adult or family shall receive family
support services from the region for which they reside.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10
He-M 523.04 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(d).
(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 523.12.
(k)
Following denial of eligibility, the individual, family, as applicable,
may reapply for services if new information regarding the diagnosis or of 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
He-M 523.05 Family Support Services.
(a)
Family support services shall:
(1) Assist young adults to identify and assess
their own needs and care;
(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; and
(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 523.07.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10
He-M 523.06 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 #97278, eff 6-18-10
He-M 523.07 PIH Family Council.
(a)
A PIH family council shall be established within each designated region.
(b)
A PIH family council shall be composed of a minimum of 5 members, all of
whom shall be, or have been, young adults or family members.
(c)
Each PIH family council shall adopt internal policies for, at a minimum,
the following:
(1) Membership, recruitment, rotation, and
requirements for service on the council;
(2) Determining the chairperson and other officers;
(3) Providing all PIH family council members
orientation and training appropriate to performing their assigned functions;
(4) Distributing family support funds and other
resources made available for family support activities; and
(5) Monitoring services and supports provided to
young adults and families in accordance with He-M 523.08.
(d)
When distributing funds, each PIH family council shall consider the
following:
(1) The needs of the young adult or family
related to chronic health condition;
(2) The level of funding and community resources
available to the young adults and family;
(3) Maintenance of sufficient funds to a given
budget cycle; and
(4) The needs within the region, as established
by the regional family support plan in He-M 523.08(b).
(e)
The PIH family council shall ensure that a young adult or family has
accessed all other available funding and community resources prior to being a
recipient of family support services funding.
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10
He-M 523.08 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
He-M 523.09 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 support coordinator, or the young adult or family;
(6) Solicit financial support for young adults
and families from community groups, foundations, and other sources to augment
state funding as needed;
(7) 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;
3. Criteria for completion; and
c. Planning for health care transitions;
(8) Maintain records regarding supports and
services provided for young adults and families; and
(9) 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; and
(2) Include the following:
a. Documentation of all contacts with the child
or his/her family or the young adult;
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
He-M 523.10 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
(from He-M 523.11)
He-M 523.11 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 of more of the
regions listed in Table 523-1:
Table
523-1, TOWNS AND CITIES BY NUMERICAL DESIGNATION AND REGION
Region
I
|
403 |
412 Dixville |
422 |
431
Stewartstown |
|
405 Carroll |
413 Dummer |
424 Northumberland |
432 |
|
406 |
414 Errol |
427 |
435 Wentworth |
|
407 Colebrook |
416 Gorham |
428 |
|
|
408 |
418 |
429 Shelburne |
436
Whitefield |
|
409 |
420 |
430 Stark |
|
Region
II
|
001 Acworth |
005 Croydon |
009 Lempster |
013 Sunapee |
|
002 |
006 |
010 |
014 Unity |
|
003 |
007 Grantham |
011 |
015 |
|
004 Cornish |
008 Langdon |
012 |
|
Region
III
|
501
|
507 |
516 |
533 |
|
101 |
508 Campton |
519 |
534 Rumney |
|
502 |
104 |
520 Holderness |
110 Sanbornton |
|
102 Barnstead |
512 Ellsworth |
107 |
535 |
|
103 |
105 Gilford |
108 Meredith |
111 Tilton |
|
506 |
106 Gilmanton |
109 New |
|
Region
IV
|
701 Allenstown |
709 |
716 Hopkinton |
723 |
|
702 |
606 Deering |
717 Loudon |
724 Sutton |
|
703 Boscawen |
710 Dunbarton |
718 Newbury |
725 Warner |
|
704 Bow |
711 Epsom |
719 |
629 Weare |
|
705 |
712 |
720 |
726 Webster |
|
706 |
713 Henniker |
721 Pembroke |
727 Wilmot |
|
707 |
714 Hill |
722 |
631 |
|
708 |
612 |
|
|
Region
V
|
301 Alstead |
610 |
312 Nelson |
317 Sullivan |
|
602 Antrim |
611 Hancock |
624 New |
318 Surry |
|
604 |
306 Harrisville |
626 |
319 Swanzey |
|
302 |
307 |
313 |
628 |
|
303 |
308 Jaffrey |
314 Rindge |
320 |
|
304 Fitzwilliam |
309 |
315 Roxbury |
321 |
|
607 Francestown |
616 Lyndeborough |
627 |
322 Westmoreland |
|
305 Gilsum |
310 |
316 Stoddard |
323 |
|
609 |
311 Marlow |
|
|
Region
VI
|
601 |
614 |
619 |
622 |
|
605 |
615 Litchfield |
620 |
630 |
|
613 Hollis |
618 Mason |
621 |
|
Region
VII
|
802 |
804 |
715 Hooksett |
617 |
|
603 |
608 Goffstown |
819 |
623 New |
Region
VIII
|
803 |
813 |
821 Newfields |
829 |
|
807 |
815 |
822 |
830 Raymond |
|
809 East |
816 |
823 |
831 |
|
810 Epping |
817 Kensington |
825 North |
834 Seabrook |
|
811 |
818 |
826 Northwood |
835 South |
|
812 |
820 |
827 |
836 Stratham |
Region
IX
|
901 |
905 Lee |
908 |
911 Rollinsford |
|
902 |
906 Madbury |
914 New |
912 Somersworth |
|
903 |
907 Middleton |
910 |
913 Strafford |
|
904 |
|
|
|
Region
X
|
801 Atkinson |
808 |
625 Pelham |
833 Sandown |
|
805 |
814 Hampstead |
828 Plaistow |
837 |
|
806 |
824 |
832 |
|
Region
XI
|
201 |
206 Eaton |
211 |
215 |
|
202 |
207 Effingham |
212 Moultonboro |
216 Tuftonboro |
|
203 |
208 Freedom |
213 Ossipee |
217 |
|
204 |
209 Hart's Location |
214 |
218 Wolfeboro |
|
205 |
210 |
|
|
Region
XII
|
509 |
515 Grafton |
522 |
530 |
|
510 |
517 |
528 Lyme |
531 Orford |
|
513 |
538 Wentworth |
|
|
Region
XIII
|
503 |
518 |
526
|
540
Sugar Hill |
|
504 |
521 Landaff |
527 Lyman |
536 |
|
505 |
523 |
529 |
537 |
|
511 |
524 |
532 Piermont |
539 |
|
514 |
525 |
|
|
Source. #7713, eff 6-21-02; ss by #9728, eff 6-18-10
He-M 523.12 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. #7713, eff 6-21-02; ss by #9728, eff 6-18-10
He-M
523.13 Waivers.
(a) A lead agency, PIH family council, family, or
young adult may request a waiver of specific procedures outlined in He-M 503
using the form titled “NH Special Medical Services –Waiver of Services.”
(b) A completed waiver request form shall be
signed by the young adult, family, lead agency, or PIH family council
representative indicating agreement with the request.
(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, meet 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,
(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. #9728, eff 6-18-10
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 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)(3)
and (4) 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
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
(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 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, 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.
(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 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.
(l) “In-home
supports” means an array of 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 524.04
(d)(1).
(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 to unlicensed personnel and:
(1) That are routine in nature;
(2) That do not require nursing
judgment; and
(3) Whose outcomes are stable and
predictable.
(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 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.
(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 is chosen or approved by the individual or
representative with input from the individual 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) Any other person chosen
by the individual or representative.
(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
that group 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
He-M 524.03 Eligibility.
(a) In-home supports
shall be available to any person under 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 Chapter He-W 600;
(3) Requires 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; and
(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 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.
(b) 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.
(c) Services
available to persons birth through 21 years of age under He-W 546, including
early and periodic screening, diagnosis, and treatment services, shall not be
provided under He-M 524.
(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
He-M 524.04 Services.
(a) An applicant for
in-home supports shall apply to the area agency in the individual’s region of
residence, as established in He-M 505.04.
(b) All in-home
supports shall be directed and managed by the individual or representative.
(c) 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.
(d) In-home supports
shall include:
(1) Personal care services that assist an
individual to continue living at home with his or her family, including
instruction and skill building to develop greater independence in:
a. Basic living skills such as 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, including use of assistive
technology;
f. Learning to make choices, to show
preferences, and to utilize opportunities for satisfying those interests;
g. Accessing and using transportation;
h. Developing and maintaining personal
relationships;
i. Participating in community experiences and
activities;
j. Pursuing interests and enhancing competencies
in leisure and avocational activities; and
k. Addressing behavioral challenges;
(2) Service coordination that:
a. Includes the following
1. Coordinating, facilitating, and monitoring
services provided under He-M 524;
2. Assessing and re-assessing service needs;
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:
(i) When the individual turns age 3, he or she
can access school services as described in He-M 510; and
(ii) When the individual turns age 21, 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. Creating and maintaining a 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; and
b. Is provided pursuant to He-M 503 or He-M 510;
(3) Any of the following consultative services
that are not otherwise available under He-W 546:
a. 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
b. 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;
(4) Respite services that are:
a. The provision of short term assistance, in or
out of an individual’s home, for the temporary relief and support of the
family; and
b. Provided pursuant to He-M 513;
(5) Environmental modifications that:
a. Consist of adaptations to the home
environment to ensure access, health, and safety;
b. Consist of adaptations to vehicles to ensure
the individual’s safety and access to the community; and
c. Are provided pursuant to He-M 517;
(6) Assistive technology services that include:
a. Evaluation, consultation, or education in the
use, selection, lease, or acquisition of assistive technology devices; and
b. Design, fitting, and customizing of devices;
and
(7) Therapeutic recreation services that include
activities such as:
a. Aquatics;
b. Hippotherapy;
c. Other sports;
d. Dramatics; and
e. Other recreational activities that promote an
individual’s health and well-being.
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
He-M 524.05 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; and
(e) All other
medicaid state plan services not described in He-M 524.04.
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
He-M 524.06 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 inform them
regarding 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 524.08 (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;
(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 524.09 (a)(7).
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
He-M 524.07 Coordination
of In-Home Supports.
(a) Once an
individual, family, and representative, choose to participate and the
individual is authorized pursuant to He-M 524.13 to receive services, a service
coordinator shall be:
(1) Chosen or approved by the individual or
representative; and
(2) Designated by the area agency.
(b) The service
coordinator shall:
(1) Maximize the extent to which an individual,
family, and representative participate in the service planning process by:
a. Explaining the service planning process;
b. Eliciting information regarding the
preferences, goals, and service needs of the individual and his or her family;
c. Reviewing issues to be discussed during
service planning meetings; and
d. 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 development of a service
agreement; and
(3) Document the service agreement.
(c) 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. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11
He-M 524.08
In-Home Supports Service Agreement.
(a) The service
agreement describing services provided pursuant to He-M 524.04 shall:
(1) Be jointly developed by the family,
individual, 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;
(2) Be incorporated into the existing document,
if the individual already has an IFSP pursuant to He-M 510.07 or service
agreement pursuant to He-M 503.11;
(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) Upon completion
of the service agreement, the individual or representative and area agency
executive director or designee shall indicate approval by signing the
agreement.
(c) 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.
(d) 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; or
(3) By the individual or representative filing a
complaint pursuant to He-M 202.
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
He-M 524.09 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, 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 524.09
through He-M 524.12;
(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 (d) 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. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11
He-M 524.10 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 524.09 (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; and
(4) Meet certification and licensure requirements
of the position, if any.
(b) All providers,
including providers who are family members, shall, prior to a final hiring
decision:
(1) Be required by the employer to consent to:
a. A New Hampshire criminal records check to
ensure that the applicant has no history of a felony conviction or misdemeanor
conviction involving:
1. Physical or sexual assault;
2. Violence or exploitation;
3. Child pornography;
4. Threatening or reckless conduct;
5. Theft; or
6. Any other conduct that represents evidence of
behavior that could endanger the well-being of an individual; and
b. A check of the state registry of founded
reports of abuse, neglect, and exploitation, as established by RSA 161-F:49, to
ensure that the applicant has no history of such actions; and
(2) Be either:
a. A minimum of
18 years of age; or
b. With the
agreement of the individual or representative, and area agency, aged 15 through
17.
(c) For the purposes
of (b)(1) above, the area agency shall be the employer for parents paid to
provide personal care.
(d) 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.
(e) Subsequent to
(d) 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.
(f) The service
coordinator shall:
(1) For individuals aged 3 and over, comply with
He-M 506.03 (c); or
(2) For individuals under age 3, comply with He-M
510.02 (ah) and He-M 510.12 (j).
(g) 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.
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
He-M 524.11
Quality Assessment.
(a) 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 individual, family, and
representative per year.
(b) The service
coordinator shall conduct visits and contacts as established by (a) above 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.
(c) 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. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11
He-M 524.12 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 524.08;
(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 524.09 (b)(2); and
(f) Any other
documentation required by the area agency or individual or representative and
specified in the 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
He-M 524.13 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 (d) 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 524.08 (d); and
(3) Denial of services by the bureau pursuant to
He-M 524.14 (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 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 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. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11
He-M 524.14 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 be made in writing to:
Bureau of
Developmental Services
105 Pleasant
Street
(f)
Once an area agency obtains a prior authorization from the bureau, it
shall submit claims for in-home supports to:
Professional
Claims
EDS
Corporation
(g)
Payment for in-home supports shall only be made if prior authorization
has been obtained from the bureau.
(h)
The bureau shall approve requests for prior authorization that meet the
criteria in (i)-(j) below, except where payments are limited pursuant to (n)
below.
(i) 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 524.10 (b)(2),
(2) Is the spouse of an individual receiving
services; or
(3) Has had a finding by the department
or any administrative agency in this state for assault, fraud, abuse, neglect,
or exploitation of any person; or
(4) Has been convicted of any offense identified
in He-M 524.10 (b)(1)a. or is listed in the state registry identified in He-M
524.10 (b)(1)b.
(j)
Payment for provision of personal care services 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 (k) 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 524.10 and all documentation requirements of
He-M 524.12.
(k)
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 culturally competence;
(4) A family’s work schedule requires that
providers be available during evening, overnight, weekend and holiday hours,
thus making it impossible 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.
(l) The area agency
shall administer payments to parents for personal care and submit requests for
parent payment to BDS for prior authorization.
(m) Payments to parents under (j) above shall apply
solely to the provision of personal care services.
(n) Payments for in-home supports shall be subject to
the following limits:
(1) The amount allotted for environmental
modifications involving fencing shall not exceed $2,500 annually;
(2) The amount allotted for therapeutic
recreation shall not exceed $1,200 annually; and
(3) The amount allotted for assistive technology not otherwise
available to a medicaid recipient, as defined in He-W 520.01 (i), shall not
exceed $1,500 annually.
(o) Other services
covered under He-M 524.04 (d)(2)-(7) shall not be eligible for payments to
parents.
(p) When a parent is
paid to provide personal care, the number of hours for which a parent will
receive payment shall be specified in the service agreement.
Source. #7891, eff 5-20-03; ss by #9122, eff 4-3-08;
ss by #10027, eff 11-17-11
He-M 524.15 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.” 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:
Office of
Client and Legal Services
105 Pleasant
Street,
(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. #7891, eff 5-20-03; ss by #9927, INTERIM, eff
5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11
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 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 supercede 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
He-M 525.02 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)
“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
(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” 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.
(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 individual’s family.
(s)
“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.
(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
He-M 525.03 Eligibility.
(a)
Participant directed and managed services 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)
Participant directed and managed services 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 He-M 525.
(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) Participant directed and managed services
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 to pose 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
(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
He-M 525.04 Non-Covered Services. The following services shall not be fundable
under He-M 525:
(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
He-M 525.05 Service Principles.
(a) Participant directed and managed services 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 participant directed and managed services may identify
others of their choice to assist them in directing their services.
(c)
Participant directed and managed
services 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)
Participant directed and managed
services 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, participant directed and managed services shall include
supports identified in the service agreement, such as:
(1) Personal care, employment supports, adult
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; and
(7) Consultations and assessments; and
(8) Services needed but not currently available.
(f)
For an individual who is under the age of 21, participant directed and managed services 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 participant directed and
managed services 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; and
(2) 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
He-M 525.06 Administrative, Service, and Personnel
Requirements.
(a) During the service planning
process, the area agency shall inform each individual and representative that
participant directed and managed
services are available as an option to them.
(b) For each individual receiving
participant directed and managed
services, the service coordinator shall develop a service agreement upon the
area agency’s identification of the availability of funding and prior to the
initiation of services.
(c) 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 specific services to be furnished;
(3) The amount, frequency, duration, and desired
outcome of each service;
(4) Timelines for initiation of services;
(5) The provider to furnish the services;
(6) Service documentation requirements for
tracking outcomes and service provision, including the type of documentation;
(7)
The frequency of service coordinator visits with the individual and contact
with the representative pursuant to He-M 525.08 (a) and (b);
(8) An individualized budget pursuant to (g)
below; and
(9) 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 participant directed and
managed services 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 participant directed and managed services 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) The
employer, or person or area agency or subcontract agency that is contracting
with a provider, shall:
a. Conduct criminal records checks and check the
state registry of founded reports of abuse, neglect, and exploitation as
established by RSA 161-F:49 for all persons who:
1. Are
being considered for a position as staff or provider; or
2. Reside
in the home of a non-family provider;
b. Provide information obtained pursuant to (3)
a. above to the area agency;
c. Obtain at a minimum one reference on each
prospective staff or non-family provider;
d.
Provide proof of insurance coverage, including general liability and workers’
compensation, to the area agency; and
e. Comply, as applicable, with all
employer-employee legal requirements such as wage reporting and tax
withholding;
(4) Upon receipt of the information pursuant to
(3) a. or b. above, an area agency, individual, or representative shall exclude
a provider or provider applicant, if he or she, or any other person residing in
the home of the provider or the provider applicant, is listed on the state
registry or has committed a crime listed in He-M 525.09 (b) (8)-(9);
(5) 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;
(6) 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;
(7) 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;
(8) 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
(9) Subsequent to (8) above and consistent with
the area agency’s or subcontract agency’s personnel policies, the employer
shall insure 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
He-M 525.07 Certification.
(a)
Participant directed and managed
services 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 participant directed
and managed services 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
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 participant directed and
managed services to ensure compliance with He-M 525 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
He-M 525.09 Denial and Revocation of Certification.
(a)
In the event of the denial or revocation of certification of participant
directed and managed services,
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 participant directed
and managed 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, provider, subcontract agency, or area agency to
comply with He-M 525 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) A
misdemeanor conviction against any staff, provider, or person living in a
non-family provider’s home that involves:
a.
Physical or sexual
assault;
b.
Violence or exploitation;
c. Child
pornography;
d.
Threatening or reckless conduct;
e. Theft;
f. Fraud;
g. Driving
under the influence of drugs or alcohol; or
h. Any
other conduct that represents evidence of behavior that could endanger the well
being of an individual;
(9) A
conviction of a felony against any staff, provider, or person living in a
non-family provider’s home; or
(10)
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 participant directed and managed services.
(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 participant directed and managed 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. #9391, eff 2-21-09; ss by #9890-A, eff
3-22-11
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
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
503.09 (d) (2) and (3); and
(5) A determination to terminate services under
He-M 503.16 (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 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’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
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 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
105
Pleasant Street
(f)
Once an area agency obtains a prior authorization from the bureau it
shall submit claims for Medicaid waiver participant directed and managed
services to:
Professional
Claims
HP
Enterprise Services
(g)
Payment for Medicaid waiver participant directed and managed services
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 participant directed and managed services 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
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.
(b) The entity requesting a waiver shall:
(1) Complete the form entitled “NH Bureau of Developmental
Services Waiver Request” (September 2013 edition);
(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; and
(3) If the waiver request is of He-M 525.09 (b)
(8) or (9), include a copy of the relevant criminal record check.
(c) All information
entered on the forms 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 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)-(j) below.
(i) 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.
(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 bureau. Such
request shall be made at least 90 days prior to the expiration of a current
waiver.
(l) A request for
renewal of a waiver shall be approved in accordance with the criteria specified
in (e) 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))
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
He-M 526.02 Definitions. The words and phrases used in these rules
shall mean the following:
(a)
“Applicant” means that legal entity which requests designation as a
receiving facility.
(b)
“Client” means a person who is receiving the services of a designated
receiving facility and:
(1) Receives services from a department-funded
developmental services program; or
(2) Receives the services of a DRF pursuant to
involuntary admission.
(c)
“Commissioner” means the commissioner of the department of health and
human services, or designee.
(d)
“Department” means the
(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 involuntarily admitted to the
state developmental services system.
(f)
“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.
(g)
“Individual treatment plan” means a plan developed by the client's
treatment team to address the client'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.
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
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) Establish written procedures by which each
client's ability to pay for services is determined; and
(2) Provide services to clients regardless of
their ability to pay; and
(3) 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
He-M 526.04 Establishment of a State DRF. The commissioner
shall establish 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.
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
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, 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 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
He-M 526.06 Staffing.
(a)
Staff of a community 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 persons admitted to the DRF; and
(3) Such clinicians as are necessary to meet the
treatment needs of the people served.
(b)
Clinicians working at a DRF may
be employed on a full-time, part-time, or consultant basis.
(c)
Professional staff of a community
DRF who provide psychotherapy shall meet the requirements of He-M 426.05.
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
He-M 526.07 Services to be Provided.
(a)
The following shall be basic services available to all clients of a
community DRF:
(1) Psychological and other clinical evaluations,
including alcohol or substance abuse evaluations, as determined necessary by a
client’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 client's problem behaviors;
(4) Case coordination provided by DRF staff,
including client evaluation, individual treatment planning, discharge planning,
and linkage with appropriate community services;
(5) Case management provided by area agency
staff, including those services outlined in He-M 526.07 (a) (4);
(6) A functional assessment of each client's
community and independent living skills; and
(7) Instruction in community and independent
living skills to prepare each client for discharge, as specified in the
client's treatment plan.
(b)
A community DRF shall have
adequate facilities to:
(1) Meet the treatment needs of the clients
served, including provision of specialized evaluation and treatment;
(2) Afford all clients 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 community DRF shall have an interagency agreement with the area agency
in the client’s region of origin or other
area agency as agreed to in the service planning process. Such an agreement shall address the discharge
planning responsibilities of the area agency and DRF.
(d)
A community DRF shall adopt policies and procedures governing seclusion
and restraint that shall be consistent with He-M 305.
(e)
A community 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.
(f)
A community 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
He-M 526.08 Safety Procedures.
(a)
A community DRF shall have
written procedures:
(1) Regarding supervision levels and the monitoring
of clients, 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 community 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 community DRF shall house non-ambulatory clients 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 that $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
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;
(5) Any reported abuse, neglect, or exploitation
of clients by DRF personnel, if:
a. Such personnel have not been prevented from
having client 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. Theft; or
g. Any other conduct that represents evidence of
behavior that could endanger the well-being of an individual; or
(8) Any illness of an applicant or program staff
member that, as evidenced by the documentation obtained and the observations
made by the department, would endanger the clients' 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 clients' 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)
(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 He-M 526.09(b)(1), a DRF shall not accept
additional clients if a notice of revocation has been issued concerning a
violation that poses potential danger to the health or safety of the clients.
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
He-M 526.10 Emergency Suspension of Designation.
(a)
If the commissioner finds at any time that the health, safety, or
welfare of clients 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 clients 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 clients 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
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
He-M 526.12 Waivers.
(a)
An applicant or DRF may request a waiver of specific procedures outlined
in He-M 526 using the form titled “NH Bureau of Developmental Services Waiver
Request.”
(b)
A waiver request shall be submitted to:
Office
of Client and Legal Services
State
Office Park South
105
Pleasant Street,
(c)
No provision or procedure prescribed by statute shall be waived.
(d)
The request for a waiver shall be granted by the commissioner within 30
days 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.
(e)
The determination on the request for a waiver shall be made within 30
days of the receipt of the request.
(f)
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.
(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)
An applicant or DRF 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. #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
PART He-M 527 ADMISSION TO AND DISCHARGE FROM A DEVELOPMENTAL
SERVICES
DESIGNATED RECEIVING
FACILITY
Statutory
Authority: New Hampshire RSA 171-A:3
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
He-M 527.02
Definitions. The words and
phrases used in these rules shall mean the following:
(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 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
(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 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) “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.
(h) “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.
(i) “Physician”
means a medical doctor licensed to practice in
(j) “Probate court”
means the state court which has authority to preside over civil commitment and
guardianship proceedings.
(k) “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
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 mental retardation; 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 DRF has the capacity to meet the person's
needs; and
(2) The DRF is the least restrictive, most
appropriate setting to meet the person’s needs.
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
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 under RSA 171-B, in
accordance with RSA 622:48 I (b).
(b) 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
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 the
parent(s) 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)
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 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 527.05(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)
He-M 527.07 Waivers.
(a) A DRF may
request a waiver of specific procedures outlined in He-M 527 using the form
titled “NH Bureau of Developmental Services Waiver Request.”
(b) A waiver request
shall be submitted to:
Office of Client and
Legal Services
State Office Park South
105 Pleasant Street,
(c) No provision or
procedure prescribed by statute shall be waived.
(d) The request for
a waiver shall be granted by the commissioner within 30 days 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.
(e) The
determination on the request for a waiver shall be made within 30 days of the
receipt of the request.
(f) 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.
(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 DRF 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. #9060, eff 1-3-08 (from He-M 527.06)
PART
He-M 528 CONDITIONAL DISCHARGE FROM A
DESIGNATED RECEIVING FACILITY
FOR
DEVELOPMENTAL SERVICES
Statutory
Authority: RSA l71-A:8-a, I
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
He-M 528.02 Definitions. The words and phrases used in these rules
shall mean the following:
(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 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
(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
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) “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.
(h)
“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.
(i)
“Law enforcement officer” means those persons identified in RSA 630:l,
II.
(j)
“State DRF” means a residential treatment program designated as a
receiving facility by the commissioner pursuant to RSA 171-A:20 and He-M 526.04
and operated by the department to provide care, custody, and treatment to
persons involuntarily admitted to the state developmental services system.
(k)
“Treatment team member” means a person who shares ongoing responsibility
for the care and treatment of a client.
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
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 commissioner only after the following actions have
been taken:
(l) A multi-level review has occurred that:
a. Incorporates:
1. Clinical input;
2. Client input; and
3. With the consent of the client or his or her
guardian, the client’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 client 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
commissioner, 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 term of discharge, including any requirement for
participation in continuing treatment in the community, and agrees to be
subject to the provisions of 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 commissioner 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 of:
a. The term 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
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;
(2) When the commissioner 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; and
(3) When the commissioner has consented to the
absolute discharge.
(b)
Consent shall be given verbally or in writing, after consideration of the
facts upon which the absolute discharge was based, if the commissioner
determines that the criteria identified in (a)(1) and (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
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
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 commissioner 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 commissioner 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 commissioner, 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 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
He-M 528.07 Revocation of Conditional Discharge.
(a)
Upon the recommendation of any treatment team member, an executive director
or designee of an area agency providing continuing treatment to a person
conditionally discharged pursuant to He-M 528.03 shall temporarily revoke a
person's conditional discharge if the area agency executive director determines
that:
(1) The person has violated a condition of the
discharge; and
(2) A condition or circumstance 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 shall conduct, or cause to be
conducted by a treatment team member, 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 circumstance
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) Notify the commissioner immediately by
telephone of the revocation to determine what state DRF has the current
capacity to provide the security and treatment the person requires;
(3) Inform the person in writing of the specific
reasons for the revocation;
(4) Identify the state DRF to which the person is
to be delivered;
(5) Direct a law enforcement officer to take
custody of the person; and
(6) Notify the state 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
state DRF identified in accordance with (f) above.
(h)
Within 48 hours of the arrival at a state DRF 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 state 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 state 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 state DRF 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
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 DRF, 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 a hearing or a review is
requested;
(3) State whether or not assistance of legal
counsel is requested at such a hearing;
(4) State whether or not the person is able to
pay for legal counsel if the assistance of counsel is requested; and
(5) 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 review or
hearing is requested, the review or hearing shall be conducted in accordance
with He-M 202.09 and He-C 200.
(e) The bureau
administrator shall obtain legal counsel for any person who requests a hearing
on the appeal and legal counsel at the hearing.
(f) Following a
hearing or review, 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 or review.
(h) The burden shall
be upon the state of New Hampshire, bureau of developmental services to establish
that the criteria for absolute revocation of the conditional discharge is 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
He-M 528.09 Waivers.
(a) A DRF may request a waiver of specific
procedures outlined in He-M 528 using the form titled “NH Bureau of
Developmental Services Waiver Request.”
(b) A waiver request shall be submitted to:
Office of Client and
Legal Services
State Office Park South
105 Pleasant Street,
(c) No provision or procedure prescribed by
statute shall be waived.
(d) The request for a waiver shall be granted by
the commissioner within 30 days 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.
(e) The determination on the request for a waiver
shall be made within 30 days of the receipt of the request.
(f) 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.
(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 DRF 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. #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
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
He-M 529.02 Definitions. The words and phrases used in these rules
shall mean the following:
(a)
“Attorney” means a lawyer retained, employed, or appointed by a court to
represent a client.
(b)
“Commissioner” means the commissioner of
the department of health and human services or designee.
(c)
“Department” means the
(d)
“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
involuntarily admitted to the state developmental services system.
(e)
“DRF administrator” means the staff member responsible for the overall
operation of a designated receiving facility, or his or her designee.
(f)
“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.
(g)
“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
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 He-M 529.03(b)-(k).
(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 or designee 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 or the administrator's
designee 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 commissioner.
(h)
Prior approval shall be given verbally or in writing, after
consideration of the facts upon which the transfer order was based, if the
commissioner 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 commissioner shall
either approve the transfer if it is determined that the criteria identified in
He-M 529.03(f) have been met or disapprove the transfer.
(l)
If the transfer is disapproved, the person shall be promptly returned to
the DRF from which he or she was transferred.
(m)
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.
(n)
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
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 commissioner, based
upon a determination that the transfer criteria specified in He-M 529.04(a)
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-M 202,
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
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 commissioner.
(b)
An 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 emergency action in accordance with He-M 202,
notwithstanding the consent of the person's guardian, if any.
(i)
A review or hearing shall be conducted in accordance with the procedures
set forth in He-M 202 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 review or 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
He-M 529.06 Waivers.
(a)
A DRF may request a waiver of specific procedures outlined in He-M 528
using the form titled “NH Bureau of Developmental
Services Waiver Request.”
(b)
A waiver request shall be submitted
to:
Office
of Client and Legal Services
State
Office Park South
105
Pleasant Street,
(c)
No provision or procedure
prescribed by statute shall be waived.
(d)
The request for a waiver shall be
granted by the commissioner within 30 days 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.
(e)
The determination on the request for a
waiver shall be made within 30 days of the receipt of the request.
(f)
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.
(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 DRF 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. #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
APPENDIX A: Incorporation by Reference Information
|
Rule |
Title |
Publisher; How to Obtain; and Cost |
|
He-M 506.02(g) |
Health Risk Screening
Tool (HRST) (2009 edition) |
DTECH Computerists,
Inc. 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. 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. 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. Phone:
800-424-3688.Website: http://www.aaidd.org/. Email: bookstore@aaidd.org. Cost: $115 |
|
He-M 517.07(e)(6)a. |
Supports Intensity
Scale (2004 edition) |
American Association
on Intellectual and Developmental Disabilities. 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. Cost: 1–100 consumers
= $699.00 each; 1–200 consumers = $899.00 each; 1–1000 consumers = $999.00
each |
|
He-M 518.10(h)(1)a. |
APSE Supported
Employment Competencies (Revision 2010) |
Publisher: Association of People Supporting Employment
First (APSE). Available online at no
cost: http://www.apse.org/docs/APSE%20Supported%20Employment%20Competencies[1]1.pdf |
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 |
|
He-M 503.06 |
RSA 171-A:6, II |
|
He-M 503.07 |
RSA 171-A:6, III |
|
He-M 503.08 |
RSA 171-A:13; 14 |
|
He-M 503.09 |
RSA 171-A:18; I |
|
He-M 503.10 |
RSA 171-A:11; 12 |
|
He-M 503.11 |
RSA 171-A:11; 12 |
|
He-M 503.12 |
RSA 171-A:11; 12; 18, I |
|
He-M 503.13 |
RSA 171-A:18, II |
|
He-M 503.14 |
RSA 171-A:1-a; RSA 171-A:6, I, IV |
|
He-M 503.15 |
RSA 171-A:6, I |
|
He-M 503.16 |
RSA 171-A:8 |
|
He-M 503.17 |
RSA 171-A:7 |
|
He-M 503.18 |
RSA 171-A:6, V |
|
He-M 503.19 |
RSA 171-A:3; 541-A:22, 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(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, II; IV |
|
He-M 505.05 (Specific paragraphs implementing specific statutes are listed below) |
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 |
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 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 9/28/119/28/11, IDEIA, Part C |
|
He-M 510.02 |
34 CFR Part 303.4-37 9/28/119/28/11; 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
; 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, 303.720-7249/28/11, 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
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, IV |
|
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 - 522.20(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 - 522.18 |
RSA 137-K:3, I, IV |
|
He-M 522.19 - 522.20 |
RSA 137-K:3, IX |
|
He-M 523.01 – 523.05 |
RSA 126-G:3; 161:2, I |
|
He-M 523.06 – 523.08 |
RSA 126-G:4; 161:2, I |
|
He-M 523.09 – 523.13 |
RSA 126-G:3; 161:2, I |
|
He-M 524.01 and He-M 524.02 |
RSA 161-I-1 |
|
He-M 524.03 |
RSA 161-I:2, IV |
|
He-M 524.04- He-M 524.06 |
RSA 161-I:1 |
|
He-M 524.07 and He-M 524.08 |
RSA 161-I:6 |
|
He-M 524.09 |
RSA 161-I:1 |
|
He-M 524.10 |
RSA 161-I:5 |
|
He-M 524.11 and He-M 524.12 |
RSA 161-I:7 |
|
He-M 524.12 |
RSA 161-I:7 |
|
He-M 524.13 |
RSA 171-A:18, II; RSA 161-I:3-a; RSA 161-I:7, VI |
|
He-M 524.14 |
RSA 161-I:7 |
|
He-M 524.15 |
RSA 161-I:7 |
|
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 - 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 527.04 |
RSA 171-A:21 |
|
He-M 527.05 |
RSA 171-A:21 |
|
He-M 527.06 |
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 |
|
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 and 171-B:15 |