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 505 - ESTABLISHMENT AND OPERATION OF AREA AGENCIES
Section He-M 505.03 - Role and Responsibilities of the Area Agency
Universal Citation: NH Admin Rules He-M 505.03
Current through Register No. 40, October 3, 2024
(a) The primary responsibility of an area agency, designated in accordance with He-M 505, shall be to plan, establish, or maintain comprehensive service access and delivery for all individuals who are residing in the area, in accordance with RSA 171-A and the rules promulgated thereunder, by:
(1)
Maintaining a current contract with the department to serve as an area
agency;
(2) Managing and providing
family support services in accordance with He-M 519;
(3) Managing and providing family centered
early supports and services in accordance with He-M 510;
(4) Providing or supporting the arrangement
of financial management services for individuals who choose to direct and
manage their waiver services;
(5)
Managing and completing intake and eligibility activities for individuals in
order to determine access to the developmental services system in accordance
with He-M 503 and He-M 522 and to facilitate and assist individuals in applying
for and maintaining Medicaid benefits;
(6) Developing and managing initial service
planning and access to supports for individuals found to be eligible for
services pursuant He-M 503, He-M 522, or He-M 524;
(7) Providing oversight and management of the
provider network by:
a. Coordinating and
monitoring the provider network to support the needs of the catchment region as
outlined in the agency's area plan, developed pursuant to
He-M
505.04(p);
b. Communicating relevant service delivery
system updates to provider agencies and provide training as needed;
c. Monitoring current service capacity using
data from the bureau to identify risk and solutions;
d. Reporting to the bureau quarterly, the
results from monitoring in c. above and follow up on actions taken pursuant to
f. below, to support provider network management;
e. Promoting the establishment of new
provider agencies to increase service capacity as determined by the bureau
based on the data provided in d. above; and
f. Providing follow-up to the bureau on
actions taken in accordance with e. above;
(8) Providing information, education, and
referrals to the service delivery system, as defined in
RSA
171-A:2, XVI, by:
a. Providing objective information and
assistance that empowers people to make informed decisions about their services
and supports; and
b. Networking and
partnering with community organizations with the goal of supporting inclusive
community life, leveraging natural resources, services, and supports, and in
improving the community's understanding of the service delivery
system;
(9) Managing
registry documentation by:
a. Assisting
individuals in the determination of and documentation of need for services to
be provided, pursuant to He-M 503, within 5 years from the date of initial
eligibility; and
b. Reviewing and
updating the registry as early as practicable anytime a need for services in
the next 5 years is identified;
(10) Submitting level of care submissions to
the bureau in accordance with He-M 517 and He-M 524 for initial level of care
determinations as well as level of care determinations for transfers between
home and community based services waivers;
(11) Initiating waiver services in accordance
with He-M 503, He-M 522, and He-M 524 including:
a. Facilitating the scheduling of an
individual's initial supports intensity scale assessment for individuals who do
not have a service coordinator;
b.
Providing resources to an individual regarding service coordination agencies so
the individual can select a service coordination provider; and
c. Following bureau approval of level of care
in accordance with He-M 503.05, submission of the
individual's selection in accordance with b. above to NH Easy for provider
review and acceptance;
(12) Maintaining and updating records in the
electronic database NH Easy at;
(13) Completing service utilization and
quality oversight by:
a. Managing service
agreement development through monthly monitoring of annual service agreement
renewals;
b. Reviewing service
agreements quarterly and communicating any identified needs to applicable
service provider agencies;
c.
Managing and overseeing submission of out-of-state service provision requests
to the bureau;
d. Monitoring
provision of services as prescribed in the service agreement by:
1. Completing annual service and post-payment
audits using a tool provided by the bureau within 60 days of request by the
bureau; and
2. Providing results of
the audits completed in accordance with (1) above to include raw data,
aggregated data, and analysis of findings;
e. Assessing annual satisfaction with quality
of services, and reviewing and continuously improving quality of services by:
1. Soliciting feedback from individuals and
families within the agency's geographic region; and
2. Providing results of the feedback received
in accordance with (1) above to include raw data, aggregated data, and analysis
of findings;
f.
Completing inquiry and review at the request of the bureau related to service
concerns, complaints, or grievances;
g. Ensuring training and education
dissemination related to identified trends of sentinel events, restraint and
seclusion, and mortality. Area agencies shall ensure that at least one training
per state fiscal year quarter is offered and provided to those who
register;
h. Collaborating with the
community mental health center that serves the region to support coordinated
service planning and delivery for individuals accessing or wishing to access
services from both service systems; and
i. Collaborating with the regional public
health network that serves the region to support emergency planning processes
in order to develop and execute response and recovery plans;
(14) Increasing access to
employment by:
a. Acting on employment trends,
as identified by the bureau; and
b.
Participating in the employment leadership committee pursuant to He-M
518;
(15) Providing
critical incident management by:
a. Collecting
restraint and seclusion data and providing such data to the bureau quarterly
with analysis of findings on a tool approved by the bureau;
b. Finalizing mortality notifications and
reviews received from provider agencies and submitting these reviews to the
bureau;
c. Finalizing sentinel
event reports and submitting these reports to the bureau;
d. Reviewing reports of incidents to
determine if a sentinel event report is needed;
e. Monitoring follow-up related to findings
from formal complaint investigations conducted pursuant to He-M 202;
f. Providing coordination, logistical
support, and subject matter expertise to service coordinators regarding crisis
mitigation situations;
g. Providing
crisis data to the bureau quarterly with analysis of any observed findings on a
tool approved by the bureau;
h.
Ensuring area agency availability 24/7 in order to provide critical incident
coordination, logistical support, and subject matter expertise;
i. Completing expedited intake and
eligibility supports to individuals who are experiencing a critical incident
but have not sought eligibility for services through the developmental services
system; and
j. Facilitating
strategy development and coordination meetings in collaboration with the
bureau;
(16) Monitoring,
maintaining, safeguarding, and promoting human rights by:
a. Maintaining and facilitating a human
rights committee, whose duties pursuant to
RSA
171-A:17 for all individuals working with the
committee, shall be;
1. Monitoring and
approving all positive behavior change programs created pursuant to
He-M
310.11;
2.
Ensuring emergency physical restraint shall only be approved for safely
responding to situations in which the individual presents with an imminent
credible risk of significant harm to self or others by staff who are trained
and certified in recognized intervention modalities;
3. Evaluating the treatment and habilitation
provided to individuals;
4.
Regularly monitoring the implementation of individual service
agreements;
5. Monitoring the use
of restrictive or intrusive interventions designed to address challenging
behavior pursuant to He-M 310.11; and
6. Promoting advocacy programs on behalf of
individuals;
b. Offering
and providing to those who register, 2 trainings per year on advocacy and
individual rights;
c. Maintaining
and distributing a list of current advocacy groups within the catchment area;
and
d. Completing informal
investigations pursuant to
He-M
202.05;
(17) Managing catchment region risk by:
a. Coordinating and facilitating a local risk
management committee whose duties shall be:
1.
Reviewing and analyzing referrals from service coordinators related to violent
aggression, problematic sexual behavior, or fire-setting behaviors;
2. Making assessment or evaluation referral
recommendations to service coordinators for individuals exhibiting behaviors
including but not limited to violent aggression, problematic sexual behaviors,
or fire-setting behaviors;
3.
Reviewing assessment and evaluation results completed for individuals for whom
a referral was submitted in accordance with 2. above to determine whether a
need is identified for a plan to manage risk;
4. Providing consultation to service
coordinators in identifying providers to create plans to manage risk who have
expertise in the areas identified in 1. above;
5. Reviewing plans to manage risk created
when a recommendation for such a plan was made pursuant to 4 above to ensure it
appropriately applies assessment or evaluation recommendations received
pursuant to 3. above;
6.
Participating in committees and other groups related to risk management
including, but not limited to, statewide risk management committees, and
communities of practice to determine application of assessment or evaluation
recommendations received pursuant to 2. above;
7. Reviewing documentation from service
coordinators and provider agencies on an ongoing basis to determine the impact
of such data relative to management of risk for an individual and related
plans;
8. Ensuring that plans to
manage risk created when a recommendation for such a plan was made pursuant to
4 above are reviewed regularly with individuals and their treatment team to
consider ongoing appropriateness and, in the event that potential changes are
indicated, seeking additional consultation with providers qualified to conduct
and author assessments, whether they created the initial plans or are new, to
discuss opportunities for modification of restrictions by sharing data
regarding the individual's progress in treatment. Such considerations shall be
made through reassessment or through a consultative review of other
documentation and updated data related to the individual's progress;
9. Offering recommendations to the area
agency for training for the service system;
10. Offering recommendations, as applicable,
to service coordinators for individual-specific training needs;
11. Conducting training related to risk
management activities, as requested by the area agency;
12. Ensuring that provider agencies and
providers are trained in risk management plans;
13. Ensuring that relevant area agency
personnel, provider agencies, and providers receive recommendations for
clinically specialized trainings, based on assessed needs of the individuals
supported, that enable these personnel to successfully complete risk management
activities; and
14. Ensuring
monthly representation in the statewide risk management committees;
and
b. Collaborate with
all area agencies to co-facilitate and convene a statewide risk management
committee;
(18) Managing
Health Risk Screening Tool (HRST) IntellectAbility accounts and data at by:
a. Providing administrative support for HRST
account management; and
b.
Completing a clinical review for individuals with a score greater than or equal
to 3;
(19) Managing New
Hampshire Easy (NH Easy) accounts and data by:
a. Ensuring that appropriate staff receive
and maintain access to NH Easy in order to carry out duties;
b. Ensuring that the area agency's NH Easy
account remains in good standing; and
c. Notifying NH Easy support of any noted
system issues;
(20)
Completing the request for the funding of a public guardian if the individual
does not have a service coordinator;
(21) Participating in medication
administration planning by:
a. Attending the
state medication committee meeting as defined in
He-M
1201.11;
b. Reviewing the 6-month medication error
reports described in He-M
1201.11(c)-(e); and
c. Offering and providing to those who
register, training to provider agencies and providers about medication
administration trends as determined by the state medication committee and
confirmed by the bureau;
(22) Completing information gathering via
survey by:
a. Disseminating and coordinating
the annual national core indicator satisfaction surveys;
b. Reviewing survey results to identify areas
of quality improvement; and
c. In
partnership with the bureau, distributing and reviewing survey results to
ensure continuous quality improvement of the service delivery system;
(23) Maintaining records pursuant
to He-M 503, He-M 510, He-M 517, He-M 519, and He-M 522, as applicable;
and
(24) Managing transitions
between regions.
(b) Failure of a provider agency to comply with the requirements in He-M 504 with respect to providing an area agency with necessary information or participating in activities in order for an area agency to carry out its responsibilities in (a) above shall not be considered noncompliance by an area agency.
(c) In instances of a provider agency failure as reflected in (b) above, the area agency shall notify the bureau within 15 days.
(d) For items (a)(4)-(24), Medicaid administrative reimbursement may be claimed by the designated and contracted area agency for activities completed each month on behalf of individuals in the area who are eligible for or seeking eligibility for Medicaid.
(e) Pursuant to RSA 171-A:18, I, the area agency shall be the primary recipient of these 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.
(f) In order to collect Medicaid administrative reimbursement, pursuant to (d) above, the area agency shall:
(1) Ensure that records are maintained to
support that the services in (a)(4)-(24) above were provided in the manner that
was claimed;
(2) Ensure that
records pursuant to (1) above are made available to the bureau or any state or
federal auditing entity; and
(3)
Provide information regarding services, supports, and costs, as requested by
the department not less than every 5 years.
(g) When possible, the area agency shall utilize community based, integrated services, rather than establish separate services for people with developmental disabilities or acquired brain disorders.
#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
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