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 517 - MEDICAID-COVERED HOME AND COMMUNITY-BASED CARE SERVICES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES AND ACQUIRED BRAIN DISORDERS
Section He-M 517.02 - Definitions

Universal Citation: NH Admin Rules He-M 517.02

Current through Register No. 40, October 3, 2024

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.

#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

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