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 549 - HOME VISITING FOR PRENATAL, CHILD, AND FAMILY SUPPORT SERVICES
Section He-W 549.07 - Required Documentation

Universal Citation: NH Admin Rules He-W 549.07

Current through Register No. 40, October 3, 2024

Participating providers shall develop and maintain on file the following documentation for each recipient:

(a) For those providers under contract with the division of public health services or the division of economic and housing stability, a plan of care shall be developed following the initial assessment, in accordance with the following:

(1) The plan of care shall include:
a. The recipient's name, date of birth, and Title XIX identification number;

b. The recipient's identified needs or risk factors;

c. The recommended home visiting for prenatal, child, and family support services; and

d. The frequency of the recommended home visiting for prenatal, child, and family support services;

(2) The plan of care shall be approved, dated, and signed by a licensed:
a. Physician, physician assistant, or advanced practice registered nurse, when the plan of care contains a nursing or bureau for family centered services specialty nutrition component; or

b. Physician, physician assistant, advanced practice registered nurse, psychologist, or mental health practitioner, when the plan of care does not contain a nursing or bureau for family centered services specialty nutrition component;

(3) The plan of care shall be reviewed and updated at least annually and as necessary, including being approved, dated, and signed in accordance with (a)(2) above; and

(4) A plan of care shall:
a. Be developed in conjunction with the family based on initial assessment;

b. Be updated at least quarterly, in conjunction with the family, based on the health care provider's assessment of progress, or lack of progress, towards the goals in (a)(4)c. below; and

c. Specify family-specific goal information, including, but not limited to:
1. The date each family-specific goal is identified;

2. Action steps to achieve each family-specific goal;

3. Frequency of services required to achieve each family-specific goal;

4. Sources of support resources for the family to utilize to achieve each family-specific goal;

5. Name and goal-related role of each anticipated and involved health care provider;

6. Dates on which progress toward each family-specific goal is to be reviewed, which shall be at least quarterly; and

7. Status of goal at review date;

(b) For those providers under contract with the division of public health services or the division of economic and housing stability, progress notes shall be prepared at the time of each visit, or at the time of the telephone call, or video conference conducted in lieu of a face-to-face visit, to include, but not be limited to:

(1) The date of each visit, telephone call, or video conference;

(2) The location of each visit, if other than the recipient's home or the participating provider or health care provider agency, and the reason therefor;

(3) The reason for a telephone call or video conference if in lieu of a visit;

(4) The individuals present at the time of the visit;

(5) The start time and end time of each visit, telephone call, or video conference;

(6) Documentation of the service(s) provided at each visit, or via telephone call or video conferencing, and how the service(s) provided relates to a specific goal; and

(7) The dated signature and credentials of the health care provider;

(c) For those providers under contract with the division of public health services or the division of economic and housing stability, documentation in the recipient's chart shall include:

(1) Family information, including, but not limited to:
a. Names of family members;

b. Dates of birth of family members; and

c. Relationship of family members to recipient;

(2) Family support team information, including, but not limited to, the name and role of each health care provider providing services; and

(3) The names and types of other sources of support being received by the recipient, including, but not limited to:
a. Primary care, dental, and mental health providers; and

b. Support from such programs as women, infants and children nutrition services and the division for children, youth and families; and

(d) Providers under contract with the bureau for family centered services to provide Special Medical Services (SMS) nutrition services as indicated in He-M 520.04(a)(2) shall develop and maintain on file the following:

(1) An evaluation plan, which shall be developed following the initial assessment and include:
a. The recipient's name, date of birth, and Title XIX identification number;

b. The recipient's identified specialty nutrition needs or risk factors; and

c. The recommended schedule for subsequent follow up visits;

(2) The evaluation plan shall be updated at least quarterly, in conjunction with the family, based on the health care provider's assessment of progress or lack of progress towards the goals in (d)(3) below;

(3) Specialty nutrition goals shall include, but not be limited to:
a. Family-specific goals, including the date each goal is identified;

b. Action steps to achieve each family-specific goal;

c. Frequency of services required to achieve each family-specific goal;

d. Sources of support resources for the family to utilize to achieve each family-specific goal;

e. Name and goal-related role of each anticipated and involved health care provider;

f. Dates on which progress toward each family-specific goal is to be reviewed, which shall be at least quarterly; and

g. Status of goal at review date;

(4) Progress notes, which shall be prepared at the time of each visit, or at the time of telephone call or video conference conducted in lieu of a face-to-face visit, by the dietician, to include, but not be limited to:
a. The date of each visit, telephone call, or video conference;

b. The location of each visit, if other than the recipient's home or the participating provider or health care provider agency, and the reason therefor;

c. The reason for a telephone call or video conference if in lieu of a visit;

d. The individuals present at the time of the visit;

e. The start time and end time of each visit, telephone call, or video conference;

f. Documentation of the service(s) provided at each visit, or via telephone call or video conferencing, and how the service(s) provided relates to a specific goal; and

g. The dated signature and credentials of the dietician;

(5) The child's health team information, including, but not limited to, the name and role of each health care provider providing services; and

(6) The names and types of other sources of support being received by the recipient, including, but not limited to:
a. Primary care, dental, and mental health providers; and

b. Programs such as women, infants and children nutrition services, partners in health, family-centered early supports and services, and other services for children with chronic conditions.

#7775, eff 10-8-02; ss by #9768, eff 10-8-10; ss by #10092, eff 3-1-12 (fr5om He-W 549.06)

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