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 544 - HOSPICE SERVICES
Section He-W 544.17 - Required Forms
Universal Citation: NH Admin Rules He-W 544.17
Current through Register No. 40, October 3, 2024
(a) Each participating hospice provider notifying the department under He-W 544.03, 544.04, 544.07, and 544.08 shall complete, as applicable, and submit Form 282A, "Medicaid Hospice Care Notification Form" (05/2012 edition) .
(b) Each participating hospice provider notifying the department under He-W 544.10 shall complete and submit Form 282B, "Service Utilization within Hospice by Recipient " (09/2010 edition) .
#9726-B, eff 7-1-10; amd by #9867-B, eff 2-11-11
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