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 517.05 - Covered Services
Universal Citation: NH Admin Rules He-M 517.05
Current through Register No. 40, October 3, 2024
(a) All services provided in accordance with the home and community-based care waiver shall be specifically tailored to, and provided in accordance with, the individual's needs, interests, competencies, and lifestyle as described in the individual's service agreement.
(b) Services provided pursuant to He-M 517 shall be designed to maintain and enhance each individual's natural supports.
(c) The services identified in (d) -(n) below shall be fundable in accordance with the home and community-based care waiver if such services are identified within an individual's service agreement or IFSP.
(d) Service coordination services shall:
(1) Be provided pursuant to
He-M
503.09 -
He-M
503.11 or
He-M
522.10 -
He-M
522.12;
(2) Include the following:
a. Monthly contacts, at a minimum, with the
individual or other people who support or serve the individual, unless more
frequent contacts are indicated by the service agreement;
b. Quarterly visits with the individual at
the individual's residence or site of service, except when a different
frequency is required subsequent to provision of participant directed and
managed services pursuant to (n) below;
c. Quarterly determination of the
individual's satisfaction with services through contact with the individual and
his or her:
1. Family;
2. Guardian;
3. Friends; or
4. Service providers, as applicable to the
individual's services;
d. Coordination and facilitation of all
supports and services delineated in the service agreement;
e. Development and revision of the service
agreement;
f. Monitoring, ongoing
review and follow-up of all service agreement services; and
g. Referral to the bureau for the assessment
of the individual's continued need for waivered services pursuant to
He-M
517.08; and
(3) Be reimbursed at a monthly
rate.
(e) Personal care services shall:
(1) Be provided pursuant to
He-M
1001.05,
He-M
525.05, or
He-M
521.03, as applicable;
(2) Consist of assistance, excluding room and
board, provided to individuals to improve or maintain their skills in basic
daily living, community integration, and personal development, as delineated in
the service agreement; and
(3) Be
reimbursed at a daily rate.
(f) Community participation services shall:
(1) Be provided in accordance with
He-M
507.04;
(2) Include the following as required by the
individual's service agreement:
a.
Instruction and assistance to learn, improve, or maintain:
1. Social and safety skills in different
community settings;
2.
Decision-making regarding choice of and participation in community
activities;
3. Life skills as
applied to community-based activities, such as purchasing items and managing
personal funds;
4. Good nutrition
and healthy lifestyle;
5.
Self-advocacy and rights and responsibilities as citizens; and
6. Any other skill identified by the
individual or guardian during service planning and related to the individual's
participation in, or contribution to, his or her community;
b. Supports to identify and
develop the individual's interests and capacities related to securing
employment opportunities, including internships;
c. Services related to job development and
on-the-job training;
d. Assistance
in finding and maintaining volunteer positions;
e. Supports related to enabling the
individual to explore, and participate in, a wide variety of community
activities and experiences in settings that are available to the general
public;
f. Consultation services as
specified in the service agreement to improve or maintain the individual's
communication, mobility, and physical and psychological health and well-being;
and
g. Transportation related to
community participation services, including travel from the individual's
residence to locations where the community participation service activities are
taking place;
(3)
Exclude employment or volunteer positions where the individual is:
a. Being solely supported by persons who are
not providers; and
b. Not receiving
any services from a provider agency at those locations; and
(4) Be reimbursed at a quarter
hour rate.
(g) Employment services shall:
(1) Be provided in
accordance with He-M 518;
(2) Be
available to any individual who:
a. Has an
employment goal; and
b. Is not
authorized and funded by the NH department' of education's bureau of vocational
rehabilitation for the same supported employment service;
(3) Consist of assistance provided to
individuals to:
a. Improve or maintain their
skills in employment activities; or
b. Enhance their social and personal
development or well-being within the context of vocational goals;
(4) Include referral, evaluation,
and consultation for adaptive equipment, environmental modifications,
communications technology or other forms of assistive technology, and
educational opportunities related to the individual's employment services and
goals;
(5) When combined with
another employment service, transportation and training in accessing
transportation, as appropriate, to and from work; and
(6) Be reimbursed at a quarter hour
rate.
(h) Respite care services shall:
(1) Be provided pursuant to
He-M
513.04 or
He-M
513.05;
(2) Consist of the provision of short-term
assistance, in or out of an individual's home, for the temporary relief and
support of the family with whom the individual lives; and
(3) Be reimbursed at a quarter hour
rate.
(i) Environmental accessibility modifications shall:
(1) Include
modifications or adaptations to the individual's home environment:
a. To ensure his or her health and
safety;
b. That are required by the
individual's service agreement; and
c. That are needed to accommodate the medical
equipment and supplies that are necessary for the welfare of the
individual;
(2) Include
modifications or adaptations to the vehicle used by the individual in order to
enable him or her to:
a. Travel in greater
safety;
b. Access the community;
and
c. Carry out activities of
daily living; and
(3)
Comply with applicable state and local building and vehicle codes.
(j) Crisis response services shall:
(1) Consist of direct consultation,
clinical evaluation or support to an individual who is experiencing a
behavioral, emotional, or medical crisis in order to reduce the likelihood of
harm to the person or others and to assist the individual to return to his or
her pre-crisis status;
(2) Include
training and staff development related to the needs of the
individual;
(3) Include on-call
staff for the direct support of the individual in crisis;
(4) Be authorized for a period of up to 6
months; and
(5) Be reimbursed at a
quarter hour rate.
(k) Community support services shall:
(1) Be
available for an individual who has developed, or is trying to develop, skills
to live independently within the community;
(2) Consist of assistance, excluding room and
board, provided to an individual to:
a.
Improve or maintain his or her skills in basic daily living and community
integration; and
b. Enhance his or
her personal development and well-being; and
(3) Be reimbursed at a quarter hour
rate.
(l) Assistive technology support services shall:
(1)
Consist of evaluation, consultation, or education in the use, selection, lease,
or acquisition of assistive technology devices, as well as designing, fitting,
and customizing of devices;
(2) Not
cover the actual cost of assistive technology devices; and
(3) Be reimbursed at quarter hour
rates.
(m) Specialty services shall:
(1) Be available to
individuals whose medical, behavioral, therapeutic, health or personal needs
require services that are particularly designed to address the unique
conditions and aspects of their developmental disabilities or acquired brain
disorders;
(2) Consist of one or
more of the following:
a.
Assessment;
b.
Consultation;
c. Design,
development and provision of services;
d. Training and supervision of staff and
providers; and
e. Evaluation of
service outcomes;
(3)
Include documentation indicating the nature of the service, date, and number of
units; and
(4) Be reimbursed at a
quarter hour rate.
(n) Participant directed and managed services shall:
(1) Be provided pursuant to He-M
525;
(2) Be available for
individuals and their families in order to improve or maintain each
individual's health and his or her experiences and opportunities in work and
community life;
(3) Consist of
assistance and resources within a flexible process that allows the family and
individual to control, to the extent desired, the service provision, including,
for each service:
a. The type;
b. The amount;
c. The location;
d. The duration; and
e. The service provider;
(4) Be based on a written proposal that
includes:
a. A description of the services to
be provided that also specifies the expenditures to be made;
b. A line-item budget; and
c. A process for measuring the individual's
degree of satisfaction with the services provided;
(5) Not be provided by the spouse of an
individual or the parent of an individual where the individual is a minor
child;
(6) Be provided by persons
qualified pursuant to
He-M
506.03 in cases where services are provided by
relatives other than parents or by friends; and
(7) Be reimbursed monthly for services
provided.
#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; amd by #9370, eff 1-24-09; ss by #10454, eff 10-31-13
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