New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-M - Former Division of Mental Health and Developmental Services
Chapter He-M 500 - DEVELOPMENTAL SERVICES
Part He-M 504 - PROVIDER AND PROVIDER AGENCY OPERATIONS
Section He-M 504.02 - Definitions

Universal Citation: NH Admin Rules He-M 504.02

Current through Register No. 40, October 3, 2024

The words and phrases used in these rules shall mean the following, except where a different meaning is clearly intended from the context:

(a) "Acquired brain disorder" means a disruption in brain functioning that:

(1) Is not congenital or caused by birth trauma;

(2) Presents a severe and life-long disabling condition which significantly impairs a person's ability to function in society;

(3) Occurs prior to age 60;

(4) Is attributable to one or more of the following reasons:
a. External trauma to the brain as a result of:
1. A motor vehicle incident;

2. A fall;

3. An assault; or

4. Another related traumatic incident or occurrence;

b. Anoxic or hypoxic injury to the brain such as from:
1. Cardiopulmonary arrest;

2. Carbon monoxide poisoning;

3. Airway obstruction;

4. Hemorrhage; or

5. Near drowning;

c. Infectious diseases such as encephalitis and meningitis;

d. Brain tumor;

e. Intracranial surgery;

f. Cerebrovascular disruption such as a stroke;

g. Toxic exposure; or

h. Other neurological disorders such as Huntington's disease or multiple sclerosis which predominantly affect the central nervous system resulting in diminished cognitive functioning and ability; and

(5) Is manifested by one or more of the following:
a. Significant decline in cognitive functioning and ability; or

b. Deterioration in:
1. Personality;

2. Impulse control;

3. Judgment;

4. Modulation of mood; or

5. Awareness of deficits;

(b) "Area agency" means "area agency" as defined in RSA 171-A:2, I-b.

(c) "Bureau" means the bureau of developmental services of the department of health and human services;

(d) "Commissioner" means the commissioner of the department of health and human services or designee;

(e) "Cost of care" means the amount of income that eligible individuals receiving home and community based waiver services are liable to contribute toward the cost of their services as specified in He-M 517;

(f) "Critical incident" means an alleged, suspected, or actual occurrence of:

(1) Abuse including physical, sexual, verbal, and psychological abuse;

(2) Neglect;

(3) Exploitation;

(4) Serious injury;

(5) Death other than by natural causes; and

(6) Other events that threaten the health or safety of an individual such as hospitalizations, administration of the wrong medication, failure to administer medication, or use of restraints or behavioral interventions that are not included in an approved behavior change program;

(g) "Days" means calendar days unless otherwise specified;

(h) "Department" means the New Hampshire department of health and human services;

(i) "Developmental disability" means "developmental disability" as defined in RSA 171-A:2, V, namely, "a disability:

(1) Which is attributable to an intellectual disability, cerebral palsy, epilepsy, autism, or a specific learning disability, or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability; and

(2) Which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe disability to such individual's ability to function normally in society.";

(j) "Enrolled provider" means a provider agency or independent provider that the department has determined is eligible to provide Home and Community Based 1915 (c) waiver services and receive payment therefore;

(k) "Guardian" means a person appointed pursuant to RSA 463 or RSA 464-A or the parent of an individual under the age of 18 whose parental rights have not been terminated or limited by law;

(l) "Home and community based waiver services" means the services defined and funded pursuant to New Hampshire's agreement with the federal government, known as the Developmental Disabilities Waiver, In-Home Supports Waiver, and the Acquired Brain Disorder Waiver, pursuant to the authority section of 1915(c) of the Social Security Act which allows the federal funding of long-term care services in non-institutional settings for persons who are developmentally disabled or who have an acquired brain disorder;

(m) "Individual" means a person who has a developmental disability or acquired brain disorder;

(n) "Medicaid" means the Title XIX and Title XXI programs administered by the department, which makes medical assistance and services available to eligible individuals;

(o) "Medicaid management information system (MMIS)" means the general system for mechanized claims processing and information retrieval recommended by the Centers for Medicare and Medicaid Services (CMS) for the implementation of the requirements of state fiscal administration pursuant to 42 CFR 433, Subpart C;

(p) "Organized health care delivery system (OHCDS)" means an area agency, designated pursuant to He-M 505, that directly provides at least one home and community based waiver service;

(q) "Pass-through billing" means an arrangement, pursuant to 42 CFR 447.10(g)(3), whereby the OHCDS is the enrolled provider of home and community based waiver services for the purposes of billing and subcontracting for the service provision and has authorization from the department to do so;

(r) "Person-centered service planning" is an individual-directed, positive approach to the planning and coordination of a person's services and other supports based on the individual's aspirations, needs, preferences, and goals;

(s) "Problematic sexual behavior" means non-consensual touching or attempting to touch another person's body in a sexualized manner, unsolicited sexualized statements, public exposure, and illegal sexual conduct whether in person or online.

(t) "Provider" means a person receiving any form of remuneration for the provision of services to an individual;

(u) "Provider agency" means an agency or an independent provider that is established to provide services to individuals;

(v) "Provider applicant" means a provider agency who is undergoing the enrollment or re-enrollment process to become a New Hampshire Medicaid provider;

(w) "Provider enrollment ID" means a unique identification number assigned to provider agencies who are enrolled in the state's Medicaid program and authorized to provide services to Medicaid beneficiaries;

(x) "Room and board" means shelter type expenses, including all property-related costs such as rental or purchase of real estate and furnishings, maintenance, utilities, and related administrative services, and 3 meals a day or any other full nutritional regimen;

(y) "Sentinel event" means an unexpected occurrence involving death or serious physical or psychological injury, or risk thereof. Serious injury specifically includes loss of limb or function. Categories of reportable sentinel events are individual-centered events, in which the individual is either a victim or perpetrator, including, but are not limited to:

(1) Any sudden, unanticipated, or accidental death, not including homicide or suicide, and not related to the natural course of an individual's illness or underlying condition;

(2) Permanent loss of function, not related to the natural course of an individual's illness or underlying condition, resulting from such causes including but not limited to:
a. A medication error;

b. An unauthorized departure or abduction from a facility providing care; or

c. A delay or failure to provide requested or medically necessary services due to waitlists, availability, insurance coverage, or resource limits;

(3) Homicide;

(4) Suicide;

(5) Suicide attempt, such as self-injurious behavior with a non-fatal outcome, with explicit or implicit evidence that the person intended to die and medical intervention was needed;

(6) Rape or any other sexual assault;

(7) Serious physical injury;

(8) Serious psychological injury that jeopardizes the person's health that is associated with the planning and delivery of care; or

(9) Injuries due to physical or mechanical restraints;

(10) High profile or high risk event, such as:
a. Media coverage; or

b. Police involvement leading to an arrest;

(z) "Service" means any paid assistance to an individual in meeting their own needs provided through the developmental services system;

(aa) "Service coordinator" means a provider who meets the criteria in He-M 503 or He-M 522 and is chosen by an individual and their guardian or representative to organize, facilitate, and document service planning and to negotiate and monitor the provision of the individual's services;

(ab) "Service coordination agency" means a provider agency providing service coordination services to individuals and licensed pursuant to He-P 819;

(ac) "Staff" means a person employed by a provider agency, subcontract agency, or other employer; and

(ad) "Utilization review and control" means the monitoring of medicaid program services pursuant to 42 CFR 455 and 42 CFR 456.

Disclaimer: These regulations may not be the most recent version. New Hampshire may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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