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 536 - MEDICAL SERVICES CLINIC
Section He-W 536.03 - Provider Participation
Universal Citation: NH Admin Rules He-W 536.03
Current through Register No. 40, October 3, 2024
All participating medical services clinics shall meet the following criteria in either (a) or (b) below:
(a) Medical services clinics that are not mobile immunization providers shall meet the following criteria:
(1) Be composed of New Hampshire licensed
practitioners who meet the provider requirements for the particular medical
service being performed as set forth in He-W 511 through He-W 577;
(2) Provide recipient care that is under the
supervision of a licensed physician affiliated with the clinic which shall mean
that:
a. The physician is readily available
to provide direction either by phone or in person;
b. The physician has seen the recipient as a
patient at least once and assesses the need for continuing care as necessary;
and
c. The physician assumes
professional responsibility for the services provided to the
recipient;
(3) Provide
medical care on an outpatient basis;
(4) Be organized and operated independently
from a hospital pursuant to
42 CFR
440.90;
(5) Be an enrolled New Hampshire medicaid
provider; and
(6) Request and
obtain prior authorization from the department before providing services which
require prior authorization as specified in He-W 511 through He-W 577;
or
(b) Medical services clinics that are mobile immunization providers shall meet the following criteria:
(1) Be composed of, and provide
immunizations by, New Hampshire licensed practitioners whose licensure allows
them to provide immunizations;
(2)
Be under contract with, or have a current vaccine provider agreement with, the
department's division of public health services;
(3) Provide immunizations to recipients in
settings such as walk-in clinics, retail stores and outlets, pharmacies, and
schools;
(4) Provide immunizations
as medicaid services only in those settings and for those types or ages of
recipients addressed in the contract or agreement in (2) above;
(5) Provide services "under the direction of
a physician", which means through standing orders or other indirect supervision
where the physician is not necessarily on site but who assumes professional
responsibility for the services provided to the recipient;
(6) Affiliate with the directing physician
through a contractual agreement or any other formal arrangement which obligates
the physician to supervise the care provided to the recipient by the
clinic;
(7) Be organized and
operated independently from a hospital pursuant to
42 CFR 440.90;
and
(8) Be an enrolled New
Hampshire medicaid provider.
(See Revision Note at chapter heading He-W 500); ss by #6133, eff 11-30-95; ss by #7825, eff 2-8-03; ss by #9860, eff 2-8-11
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