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 521 - CERTIFICATION OF RESIDENTIAL SERVICES OR COMBINED RESIDENTIAL AND COMMUNITY PARTICIPATION SERVICES PROVIDED IN THE FAMILY HOME
Section He-M 521.13 - Payment

Universal Citation: NH Admin Rules He-M 521.13

Current through Register No. 40, October 3, 2024

(a) In order to receive funding under He-M 521, services shall be certified by the bureau in accordance with He-M 521.09.

(b) Community-based care providers shall submit claims for covered community-based care services on to:

Xerox Provider Services

ATTN: Claims Administration

P. O. Box 2003

Concord, NH 03302-2003

(c) Payment for community-based care services shall only be made if prior authorization has been obtained from the bureau.

(d) Requests for prior authorization shall be made in writing to:

Xerox Provider Services ATTN: Claims Administration

PO Box 2003

Concord, NH 03302-2003

(e) For those individuals whose net income exceeds the appropriate standard of need, Medicaid claims payment will reflect a reduction in reimbursement equal to the cost of care amount..

(f) In those situations where cost of care is subtracted from the Medicaid billings, the area agency shall recover the cost from individuals unless they qualify for Medicaid for employed adults with disabilities (MEAD) pursuant to He-W 641.03.

(g) Payment for services shall not be available to any service provider who:

(1) Is a person under age 18; or

(2) Is the spouse of an individual receiving services.

#9475, eff 5-22-09

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