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 552 - PERSONAL CARE ATTENDANT SERVICES
Section He-W 552.03 - Recipient Eligibility
Universal Citation: NH Admin Rules He-W 552.03
Current through Register No. 40, October 3, 2024
(a) Medicaid recipients shall be eligible for PCA services when the recipient:
(1) Is at
least 18 years of age;
(2) Is
his/her own legal guardian;
(3) Is
chronically wheelchair-mobile;
(4)
Is approved to participate in an independent living program by provider of PCA
services;
(5) Is able to
participate fully in activities of daily living (ADLs), which are the basic
self-care tasks of everyday life, such as eating, bathing, dressing, toileting,
and transferring;
(6) Is able to
self direct, which means the recipient is capable of:
a. Making informed choices about his or her
PCA services; and
b. Selecting,
directing, supervising and managing the personal care attendant in the
implementation of a plan of care;
(7) Is living in a non-institutional
environment, but requires a minimum of 2 hours of medically oriented PCA
services per day; and
(8) Has a
demonstrated need for PCA services as required by (c) below.
(b) The requirements in (a) (6) above shall not preclude the recipient from obtaining assistance with the task of selecting and directing the personal care attendant.
(c) A demonstrated need for PCA services shall be documented by:
(1) Documentation
from the recipient's physician that includes:
a. A statement certifying that, based on the
physician's assessment of the recipient's abilities and of the frequency and
scope of the acute medical interventions needed by the recipient, PCA services
are necessary and appropriate;
b. A
description of the specific PCA services and tasks that the recipient needs
assistance with; and
c. The number
of hours of PCA services needed on a daily or weekly basis; and
(2) Documentation signed by the
recipient indicating that the recipient's needs cannot be fully met with
natural supports, and includes:
a. A
statement attesting that the PCA services are intended to assist, not replace
or supplant the help already available to the recipient from family members,
community resources, or other natural supports; and
b. Information detailing why the legally
responsible relative is not able to provide the care that is needed, such as
physical limitations or a work schedule that limits their
availability.
(See Revision Note at chapter heading He-W 500); ss by #4993, eff 11-30-90, EXPIRED: 11-30-96
New. #6742, eff 4-30-98; ss by #8597, eff 3-30-06; ss by #10562, INTERIM, eff 3-30-14, EXPIRES: 9-26-14; ss by #10676, eff 9-26-14 (from He-W 552.02)
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