New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-E - Former Division of Elderly and Adult Services
Chapter He-E 500 - SOCIAL SERVICES
Part He-E 501 - THE SOCIAL SERVICES BLOCK GRANT (TITLE XX)
Section He-E 501.16 - Service Authorization
Current through Register No. 40, October 3, 2024
(a) Once an applicant has been determined eligible to receive Title XX services, one or more of the following services shall be authorized by the provider based on the needs identified in the individual's person-centered plan:
(b) The provider shall complete Form 3502, "Contract Service Authorization-New Authorization" (November 2019) and submit to:
Department of Health and Human Services
Bureau of Data Management
129 Pleasant Street
Concord, NH 03301
(c) Payment shall not be made to the provider unless Form 3502, "Contract Service Authorization" (September 2014) is submitted to data management as indicated above.
#9849-A, eff 1-12-11