New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-W - Former Division of Human Services
Chapter He-W 500 - MEDICAL ASSISTANCE
Part He-W 530 - SERVICE LIMITS, CO-PAYMENTS, AND NON-COVERED SERVICES
Section He-W 530.03 - Service Limits

Universal Citation: NH Admin Rules He-W 530.03

Current through Register No. 40, October 3, 2024

The following service limits shall apply to each recipient who is subject to service limits, per state fiscal year, with exceptions noted:

(a) The hearing aid evaluation or a hearing aid consultation shall be limited to one service every 2 years since the last date of service;

(b) Hospital services shall be limited as follows:

(1) Outpatient hospital services shall be limited to 12 visits per state fiscal year;

(2) Services provided in an emergency department (ED) or an urgent care setting shall not be considered outpatient hospital services, and shall not apply toward the limit established in (1) above;

(3) Physician services shall be unlimited except when associated with an outpatient hospital visit, in which case they shall be limited to 12 visits per state fiscal year; and

(4) Services that are described individually in component parts of this chapter, such as therapy services or radiology services, and that are associated with an outpatient hospital, ED or urgent care visit shall be subject to the service limits which apply to that individual service;

(c) Physician and advanced practice registered nurse (APRN) services performed in the inpatient hospital setting shall be limited to one visit per each day of stay approved by the department or its designated quality improvement organization (QIO) as defined in He-W 531.01(h) ;

(d) Podiatry services shall be limited to 4 visits;

(e) Therapy services, including physical, occupational and speech therapy, shall be limited to 80, 15-minute units per recipient. The 80 units may be used for one type of therapy or for any combination of therapies;

(f) Vision care services shall be limited as follows:

(1) One refraction to determine the need for glasses, no more frequently than every 12 months;

(2) Replacement of lenses or at the discretion of the recipient, lenses and frames, when the refractive error changes .50 diopter or more in both eyes;

(3) Replacement of nickel frames after 12 months, if the recipient has a documented allergy to nickel demonstrated by skin irritation and wearing down of the frame in the affected area; and

(4) One repair of glasses every 12 months, including replacement of the broken part(s) only;

(g) Wheelchair van services shall be limited to 24 trips, either one-way or round trip;

(h) X-ray services shall be limited as follows:

(1) X-ray services for diagnostic purposes shall be limited to 15 x-rays; and

(2) X-ray services provided for radiation therapy shall not be limited; and

(i) If a recipient is covered by medicare and medicare pays at least half the medicaid program rate for a covered service which is subject to limits, that service shall not be counted against such limits.

(See Revision Note at chapter heading He-W 500); ss by #4863, eff 7-12-90; amd He-W 530.03(d) by #5714, eff 10-1-93; amd He-W 530.03(f) by #6050, eff 6-17-95; ss by #6925, eff 1-1-99; ss by #8780, INTERIM, eff 1-1-07, EXPIRES: 6-30-07; ss by #8929, eff 6-30-07; amd by #8983, INTERIM, eff 9-21-07, EXPIRES: 3-19-08; amd by #9103, eff 3-12-08; amd by #9366, eff 1-17-09; amd by #9622, eff 1-1-10; amd by #9736, eff 6-25-10; amd by #10017, eff 11-1-11; amd by #10090, eff 3-1-12; amd by #10427, eff 9-28-13; amd by #10657, eff 8-15-14

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