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 522 - ELIGIBILITY DETERMINATION AND SERVICE PLANNING FOR INDIVIDUALS WITH AN ACQUIRED BRAIN DISORDER
Section He-M 522.02 - Definitions

Universal Citation: NH Admin Rules He-M 522.02

Current through Register No. 40, October 3, 2024

(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) "Advanced crisis funding" means revenue authorized by the department of health and human services (department) when funds are not otherwise available for an individual who is in crisis as described in He-M 522.14(k) and requires services immediately.

(d) "Area agency" means "area agency" as defined in RSA 171-A:2, I-b.

(e) "Area agency director" means that person who is appointed as executive director or acting executive director of an area agency by the area agency's board of directors.

(f) "Assistive technology" means technology designed to be utilized in an "assistive technology device" as defined in 29 U.S.C. section 3002(4) or "assistive technology service" as defined in 29 U.S.C. section 3002(5) .

(g) "Basic service agreement" means a written agreement between the individual, guardian, or representative and the area agency that is prepared pursuant to He-M 522.11 for each individual receiving services and that outlines the services and supports to be provided.

(h) "Brain Injury Community Supports" means services administered through the Brain Injury Association of New Hampshire that:

(1) Are provided to persons with an acquired brain disorder who are eligible for services pursuant to He-M 522.03 (a) but do not meet the eligibility criteria in He-M 517.03 (a) for Medicaid home- and community-based care; and

(2) Include, at a minimum the following services when such services are not reimbursable by Medicaid or other insurance:

a. Home modification;

b. Respite service;

c. Assistive technology;

d. Specialized equipment;

e. Transportation;

f. Short-term financial assistance, such as for utilities or rent;

g. Therapeutic evaluations; and

h. Other similar limited or nonrecurring services necessary for an individual to live as safely and independently as possible in his or her community.

(i) "Bureau" means the bureau of developmental services of the department of health and human services.

(j) "Bureau administrator" means the chief administrator of the bureau of developmental services.

(k) "Commissioner" means the commissioner of the department of health and human services or his or her designee.

(l) "Department" means the New Hampshire department of health and human services.

(m) "Developmental disability" means "developmental disability" as defined in RSA 171-A:2, V, namely, a disability:

(1) "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

(2) "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."

(n) "Direct and manage" means to be actively involved in all aspects of the service arrangement, including:

(1) Designing the services;

(2) Selecting the service providers;

(3) Deciding how the authorized funding is to be spent based on the needs identified in the individual's service agreement; and

(4) Performing ongoing oversight of the services provided.

(o) "Expanded service agreement" means a written agreement between the individual, guardian, or representative and the area agency that is prepared pursuant to He-M 522.11 and describes services pursuant to He-M 1001, He-M 521, He-M 525, He-M 507, and He-M 518.

(p) "Family support coordinator" means an area agency staff member who provides assistance to families in accordance with He-M 519.04.

(q) "Guardian" means a person appointed pursuant to RSA 463, RSA 464-A, or a parent or guardian of an individual under the age of 18 whose parental rights have not been terminated or limited by law in such a way as to remove the parent or guardian's right to make decisions pursuant to RSA 171-A on behalf of the individual.

(r) "Health Risk Screening Tool (HRST) " means the 2015 edition of the Health Risk Screening tool, available as noted in Appendix A, which is a web-based rating instrument used for performing health risk screenings on individuals in order to:

(1) Determine an individual's vulnerability regarding potential health risks; and

(2) Enable the early identification of health issues and monitoring of health needs.

(s) "Home and community-based services" means medicaid services pursuant to He-M 517.

(t) "Individual" means a person with an acquired brain disorder who is eligible to receive services pursuant to He-M 522.03.

(u) "Informed consent" means a decision made voluntarily by an individual or applicant for services or, where appropriate, such person's legal guardian or representative, after all relevant information necessary to making the choice has been provided, when the person understands that he or she is free to choose or refuse any available alternative, when the person clearly indicates or expresses his or her choice, and when the choice is free from all coercion.

(v) "Intellectual disability" means "intellectual disability" as defined in RSA 171-A:2, XI-a, namely, "significantly sub-average general intellectual functioning existing concurrently with deficits in adaptive behavior, and manifested during the developmental period. A person with an intellectual disability may be considered mentally ill provided that no person with an intellectual disability shall be considered mentally ill solely by virtue of his or her intellectual disability."

(w) "Local education agency (LEA) " means "local education agency" as defined in 34 CFR 300.28 and Ed 1102.03 (o) .

(x) "Medicaid home- and community-based care services" means services provided in accordance to He-M 517.

(y) "Mental illness" means a condition of a person who is or has been determined severely mentally disabled in accordance with He-M 401.05 through He-M 401.07 and who has at least one of the following psychiatric disorders classified in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition, Text Revision) (DSM-5), available as listed in Appendix A:

(1) Schizophrenia spectrum and other psychotic disorders, except for the following:

a. Schizotypal personality disorder;

b. Substance or medication induced psychotic disorder; and

c. Psychotic disorder due to another medical condition;

(2) Bipolar and related disorders, except for the following:

a. Substance or medication induced bipolar and related disorder; and

b. Bipolar disorder and related disorder due to another medical condition;

(3) Depressive disorders, except for the following:

a. Disruptive mood dysregulation disorder;

b. Premenstrual dysphoric disorder;

c. Substance or medication induced depressive disorder; and

d. Depressive disorder due to another medical condition;

(4) Borderline personality disorder;

(5) Panic disorder;

(6) Obsessive compulsive disorder;

(7) Post traumatic stress disorder;

(8) Bulimia nervosa;

(9) Anorexia nervosa;

(10) Other specific feeding or eating disorders;

(11) Unspecified feeding or eating disorders; and

(12) Major neurocognitive disorders where psychiatric symptom clusters cause significant functional impairment and one or more of the following symptom categories are the focus of psychiatric treatment:

a. Anxiety;

b. Depression;

c. Delusions;

d. Hallucinations;

e. Paranoia; and

f. Behavioral disturbance.

(z) "Participant directed and managed services" means services provided pursuant to He-M 525 whereby the individual or representative, if applicable, directs and manages the services, as defined in (n) above. Services include assistance and resources to individuals in order to maintain or improve their skills and experiences in living, working, socializing, and recreating.

(aa) "Personal profile" means a narrative description that includes:

(1) A personal statement from the individual and those who know him or her best that summarizes the individual's strengths and capacities, communication and learning style, challenges, needs, interests, and any health concerns, as well as the individual's hopes and dreams;

(2) A personal history covering significant life events, relationships, living arrangements, health, and use of assistive technology, and results of evaluations which contribute to an understanding of the person's needs;

(3) A review of the past year that:

a. Summarizes the individual's:

1.Personal achievements;

2.Relationships;

3.Degree of community involvement;

4.Challenging issues or behavior;

5.Health status and any changes in health; and

6.Safety considerations during the year;

b. Addresses the previous year's goals with a level of success and, if applicable, identifies any obstacles encountered;

c. Identifies the individual's goals for the coming year;

d. Identifies the type and amount of services the individual receives and the support services provided under each service category;

e. Identifies the individual's health needs;

f. Identifies the individual's safety needs;

g. Identifies any follow-up action needed on concerns and the persons responsible for the follow-up; and

h. Includes a statement of the individual's and guardian's satisfaction with services;

(4) An attached work history of the person's paid employment and volunteer positions, as applicable, that includes:

a. Dates of employment;

b. Type of work;

c. Hours worked per week; and

d. Reason for leaving, if applicable; and

(5) A reference to sensitive historical information in other sections of the chart when the individual, guardian, or representative, as applicable, prefers not to have this included in the profile.

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

(ac) "Provider agency" means an area agency or another entity under contract with an area agency to provide services.

(ad) "Region" means "area" as defined in RSA 171-A:2, I-a, namely, "a geographic region established by rules adopted by the commissioner for the purpose of providing services to developmentally disabled persons."

(ae) "Representative" means:

(1) The parent or guardian of an individual under the age of 18;

(2) The guardian of an individual 18 or over; or

(3) A person who has power of attorney for the individual granting specific authority to make the required decision.

(af) "Risk assessment" means an evaluation administered pursuant to He-M 522.10 (d) (13) using evidence-based tools to evaluate an individual's behaviors and determine the potential risks to the individual or others posed by said behaviors.

(ag) "Service" means any paid assistance to the individual in meeting his or her own needs provided through the area agency.

(ah) "Service agreement" means a written agreement between the individual, guardian, or representative and the area agency that was prepared as a result of the person-centered planning process and that describes the services that an 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 522.11.

(ai) "Service coordinator" means a person who meets the criteria in He-M 522.09 (e) -(f) and is chosen or approved by an individual and his or her guardian or representative 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 who does not provide or have oversight of any direct services for the individual;

(2) A member of the individual's family;

(3) A friend of the individual; or

(4) Another person chosen to represent the individual.

(aj) "Service planning meeting" means a gathering of 2 or more people, one of whom is the individual who receives services unless he or she chooses not to attend, called to develop, review, add to, delete from, or otherwise change a service agreement.

(ak) "Specific learning disability" means a chronic condition of presumed neurological origin that selectively interferes with the development, integration, or demonstration of verbal or non-verbal abilities, and constitutes a severe disability to such individual's ability to function normally in society. The term includes such conditions as perceptual handicaps, brain injury, dyslexia, and developmental aphasia. The term does not include individuals who have learning problems which are primarily the result of visual, hearing, or motor handicaps, intellectual disability, emotional disturbance, or environmental, cultural, or economic disadvantage.

(al) "State of residence" means the state of residence as defined in 42 CFR 435.403.

(am) "Supports intensity scale (SIS) " means the 2004 edition of the Supports Intensity Scale, available as noted in Appendix A, which is an assessment tool intended to assist in service planning by measuring the individual's support needs in the areas of home living, community living, lifelong learning, employment, health and safety, social activities, protection, and advocacy. The tool uses a formal rating scale to identify the type of supports needed, frequency of supports needed, and daily support time.

(an) "Termination" means the cessation of a service by an area agency director with or without the informed consent of the individual or his or her guardian or representative.

(ao) "Vacancy" means funds that become available when an individual stops receiving acquired brain disorder services.

(ap) "Wait list" means a list of individuals who need and are ready to receive services, are medicaid eligible, but who do not have funding for services needed.

(aq) "Withdrawal" means the choice of an individual or his or her guardian to discontinue that individual's participation in a service.

#7120, eff 10-20-99; ss by #8974, INTERIM, eff 10-6-07, EXPIRED: 4-3-08

New. #9734, eff 6-25-10; ss by #12683, eff 11-30-18

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