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 548 - EXTENDED SERVICES TO PREGNANT WOMEN
Section He-W 548.06 - Required Documentation

Universal Citation: NH Admin Rules He-W 548.06

Current through Register No. 40, October 3, 2024

The provider shall maintain the following documentation for all extended services care provided:

(a) A plan of care containing:

(1) The initial assessment, which shall contain:
a. The recipient's name and medicaid identification number;

b. The date of entry into clinic service;

c. The number of weeks of gestation at the date of entry;

d. The recipient's medical, nutritional, and social needs and risks;

e. A listing of services and types of providers to be used, to address the recipient's needs and risks, as well as the frequency of services;

f. A dated signature on the plan of care by the physician or advanced practice registered nurse, or a physician assistant if so delegated by a physician in accordance with Med 603.01, along with the signature of the recipient, approving the plan of care;

g. A statement signed by the recipient which gives the agency staff permission to discuss the recipient's needs with other medical and social service caregivers; and

h. The date of, and reason for, discharge from the program;

(2) Ongoing plan of care notes, relating to the original plan of care, containing:
a. Date(s) of service(s); and

b. Description of service(s); and

(3) Changes to the original plan of care described in (1) d. and (1) e. above, to be attached to the original plan of care;

(b) Attendance records for any group education attended by a recipient;

(c) An extended services summary sheet listing the recipient's name and medicaid identification number, and the date(s) and type(s) of extended service(s) rendered;

(d) Supporting records in accordance with He-W 520 and this part, and failure to maintain records in accordance with He-W 520 and this part shall entitle the department to recoupment of state and federal medicaid payments made as permitted by 42 CFR 455 and 42 CFR 447; and

(e) Documentation required by He-W 520 and this part for a minimum of 6 years or until the resolution of any legal action(s) commenced within the 6 year period, whichever is longer.

(See Revision Note at chapter heading He-W 500); ss by #5578, eff 2-11-93; ss by #6939, Interim, eff. 1-30-99, EXPIRED 5-30-99

New. #7036, eff 6-25-99; ss by #8904, eff 6-25-07

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