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 552.06 - Non-covered Services
Universal Citation: NH Admin Rules He-W 552.06
Current through Register No. 40, October 3, 2024
(a) Non-covered services shall be those services for which the NH Medicaid program shall make no payment.
(b) The following activities shall not be considered PCA services:
(1) Services that
are not medically oriented, including:
a.
Shopping, except for grocery shopping;
b. Managing finances;
c. Care, grooming, or feeding of pets or
other animals, with the exception of service animals as defined by the
Americans with Disabilities Act (ADA), Title III Subpart A 36.104, or
assistance animals as defined by the Fair Housing Act Section 504;
and
d. Social integration
activities, such as accompanying the recipient to a restaurant, to the movies,
to a ball game or to any other community or social activity;
(2) Chore services, which are
tasks that exceed light housekeeping and include:
a. Cleaning of floors, shampooing carpets,
cleaning walls, and cleaning furniture in areas not occupied by the recipient,
such as cleaning the entire home rather than the area the recipient
occupies;
b. Doing laundry, other
than the recipient's personal laundry, such as doing laundry for the household
as opposed to just the recipient's personal laundry;
c. Cleaning windows; and
d. Doing yard work, gardening, home repairs,
or shoveling snow unless needed to ensure the recipient's and the PCA's safe
access to and from the recipient's home when the recipient has no natural
supports;
(3) Services
provided outside the recipient's home for the convenience of the personal care
attendant, such as care provided at the personal care attendant's home, or any
other location where the recipient would not normally go within the
community;
(4) Services performed
for the convenience of the recipient, or the recipient's family member(s), or
intended to otherwise replace assistance available through the recipient's
natural supports system;
(5) Time
spent with the recipient when no actual hands on care or other covered services
are being provided, including but not limited to supervision, companion care,
baby-sitting the recipient's dependents, or social visits;
(6) Services provided to a recipient while
the recipient is:
a. An inpatient or resident
of a hospital, nursing facility, intermediate care facility for the mentally
retarded, or institution for mental disease, in accordance with
42 CFR
440.167;
b. An inmate of a public institution in
accordance with 1905(a) (27) (A) of the Social Security Act; or
c. Attending a program for which personal
care services are already provided, such as adult medical day care;
(7) Services provided to the
recipient outside the United States;
(8) Duplicative PCA services;
(9) Any services not listed as covered under
He-W
552.05;
(10) Services which are not included in the
approved plan of care;
(11)
Services provided to someone other than the recipient; and
(12) Care requiring the technical or
professional skill that a state statute or regulation mandates must be
performed by a health care professional licensed or certified by the
state.
(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 553.06)
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