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 589 - Medical Assistance Services Provided by Education Agencies
Section He-W 589.08 - Documentation of Expenditure of Non-Federal Funds
Universal Citation: NH Admin Rules He-W 589.08
Current through Register No. 40, October 3, 2024
(a) The enrolled school provider shall provide documentation annually regarding all services rendered pursuant to these rules.
(b) Such documentation shall:
(1) Demonstrate that:
a. The percentage of federal medical
assistance reimbursed, as required by section 1905(b) of the Social Security
Act, does not exceed 50% of the actual cost of covered services claimed under
medicaid; and
b. In no case are
services that are reimbursable under medicaid, but paid by other federal
funding, claimed by the enrolled school provider under NH medicaid;
(2) Be reviewed and signed by the
enrolled school provider's superintendent;
(3) Be submitted to the department no later
than October 30 of each year for the preceding fiscal year period;
and
(4) Be accompanied by a
completed form "Documentation of Expenditure of Non-Federal Funds" (2/2020) for
a specific July 1 through June 30 time period which includes an attestation
signed and dated by the superintendent stating:
"I hereby certify that all Medicaid funds paid to the above named districts under He-W 589, Medical Assistance Services Provided by Educational Agencies for the period July 1, xxxx through June 30, xxxx have been supplemented with LEA/SAU and/or non-federal funds to total 100% of the cost of services rendered and that the Medicaid reimbursement does not exceed 50% of the total cost of the services rendered."
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