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. 13, March 27, 2025

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 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) "Agency residence" means a community residence operated by staff of a provider agency;

(d) "Basic living skills" means activities accomplished each day to acquire, improve, 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 their 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 their 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 517.05(e)(7);

(k) "Cost of care" means the amount that an individual pays to a provider agency because the individual's net income is above the applicable standard of need established in He-W 658.03;

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

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

(n) "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 disability to such individual's ability to function normally in society.";

(o) "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 (r) below;

(p) "Family residence" means a community residence that is:

(1) Operated by a person or family residing therein;

(2) Under contract with a provider agency; and

(3) Certified pursuant to He-M 1001;

(q) "Home and community-based waiver services (HCBS waiver services)" means the services defined and funded pursuant to New Hampshire's agreement with the federal government, known as the "Developmental Disabilities 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;

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

(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) "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;

(u) "Participant directed and managed services (PDMS)" means services provided pursuant to He-M 525;

(v) "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;

(w) "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;

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

(y) "Provider agency" means an agency or an independent provider that is established to provide services to individuals pursuant to He-M 517.05 and meets the criteria in He-M 504;

(z) "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;

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

(ab) "Service agreement" means a written agreement between the individual, guardian, or representative, and the provider agency that is prepared as a result of the person-centered service planning process and that describes the services that the individual will receive and constitutes an individual service agreement as defined in RSA 171-A:2, X and developed pursuant to He-M 503.10 or He-M 522.11;

(ac) "Service coordinator" means a provider who meets the criteria in He-M 503.08 or He-M 522.09 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;

(ad) "Sheltered workshop" means a program that provides a segregated environment where the contract objectives of the provider agency are the primary focus and goal; and

(ae) "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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