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 504.06 - Pass-Through Billing
Universal Citation: NH Admin Rules He-M 504.06
Current through Register No. 40, October 3, 2024
(a) Pass-through billing shall be permissible for the following home and community based waiver services:
(1) Assistive technology;
(2) Environmental and vehicle modification
services;
(3) Individual goods and
services;
(4) Non-medical
transportation;
(5) Personal
emergency response system;
(6)
Community integration services;
(7)
Respite;
(8) Wellness coaching;
and
(9) Specialty services for
assessments, consultations, and evaluations.
(b) An OHCDS that provides pass-through billing shall:
(1) Establish itself as the
enrolled provider for the home and community based waiver service(s) in (a)
above for which pass-through billing will be done;
(2) Hold a contract or other agreement with a
provider or provider agency for service provision, except that provision of
goods, other than environmental or vehicle modifications, shall not require a
contract or agreement;
(3) Ensure
that the providers and provider agencies with whom it contracts, or has
agreements with, meet:
a. The service and
provider qualification standards under the applicable home and community based
services waiver, He-M 504 and He-M 506 to provide the services pursuant to (1)
above;
b. Medicaid requirements and
are free from sanctions or exclusions or are otherwise not excluded from
receiving medicaid reimbursement;
c. Medicaid office of inspector general
screening requirements prior to service delivery and monthly
thereafter;
d. All federal and
state rules and requirements; and
e. All applicable regulatory and industry
standards and maintains good standing as a provider agency;
(4) Submit claims to MMIS for
rendered services and goods and ensure that records are maintained to verify
that such services and goods were provided in the amount, scope, and frequency
that was claimed;
(5) Reimburse
subcontractors;
(6) Submit to the
bureau within 30 days of the close of the state fiscal year, in addition to all
other required reports and statements, an aggregate annual summary delineating
OHCDS activities, including subcontractor names, amounts paid per
subcontractor, nature of services, and number of individuals served by each
subcontractor;
(7) Ensure that it
maintains detailed records, available for the department, its designee, or
respective individual, at request for review at any time, to verify the
purchase of services and goods outlined in (a) above; and
(8) Ensure that policies and practices do
not:
a. Restrict any home and community-based
waiver services provider agency or provider to participate only through an
OHCDS and that such arrangements are voluntary; and
b. Restrict individuals into securing
services exclusively through an OHCDS.
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