New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-W - Former Division of Human Services
Chapter He-W 600 - FINANCIAL ASSISTANCE AND ELIGIBILITY FOR MEDICAL CARE
Part He-W 619 - PRESUMPTIVE ELIGIBILITY FOR HOME AND COMMUNITY-BASED CARE FOR_THE ELDERLY AND CHRONICALLY ILL (HCBC-ECI)
Section He-W 619.02 - Presumptive Eligibility For HCBC-ECI
Universal Citation: NH Admin Rules He-W 619.02
Current through Register No. 40, October 3, 2024
(a) Presumptive eligibility for medicaid services shall be available to the applicant:
(1) Who applies for HCBC-ECI;
(2) Who requests a presumptive eligibility
determination, either directly or through a qualified provider;
(3) Who submits a completed medicaid
application and all related, necessary verifications as contemplated at He-W
606, within 10 days;
(4) Who
undergoes a face-to-face clinical assessment by a registered nurse designated
by the department's bureau of elderly and adult services (BEAS);
(5) Who the department or qualified provider
determines in accordance with
He-W
619.02(b) is likely to be at risk of
institutionalization without HCBC-ECI services;
(6) Who the department determines is likely
to be medicaid-eligible in accordance with
He-W
619.02(c) ;
(7) Who has not previously applied for or
received PE coverage in the previous 12 months; and
(8) Who acknowledges in writing his or her
understanding and agreement that if the application is denied for any reason,
the applicant shall be responsible for:
a.
The cost of services rendered after a determination of ineligibility;
and
b. The cost of services
rendered during the presumptive eligibility period, if the department finds the
application was filed with fraudulent intent.
(b) Individuals shall be determined by the department or qualified provider to be at risk of institutionalization if:
(1) Adult protective services has made a
finding of abuse, neglect or exploitation and recommends home and community
based care services because of a risk of institutionalization;
(2) The individual is in a hospital, nursing
facility or other medical facility, ready to be discharged, and the discharge
planning team determines that the individual cannot be discharged home without
supports in addition to those already available to him or her.
(3) The individual has lost the assistance of
a family or other caregiver, permanently or temporarily, whom the individual
has depended on to meet his or her needs and no other alternatives are
available; or
(4) The individual
does not have access to sufficient paid and/or unpaid supports that would
enable the individual to safely maintain him or herself in the current home or
community-based setting pending the routine eligibility determination
process.
(c) An individual who requests a presumptive eligibility determination shall be considered likely eligible for medicaid if the individual requires a nursing facility level of care and meets one of the following:
(1) The individual is a medicaid
recipient;
(2) The individual was
previously eligible for HCBC-ECI services but:
a. The department closed the case due to an
institutional stay of more than 30 days;
b. There is no change in financial
circumstances; and
c. The
individual is ready to return to the community;
(3) The individual was previously eligible
for HCB-ECI services but:
a. The department
closed the case due to a lump sum payment or other change in circumstances;
and
b. Such cause is no longer an
impediment to eligibility;
(4) The individual is a medicaid applicant
who is age 65 or older, whose completed application indicates general and
financial eligibility, and who does not benefit from a trust or annuity and has
not transferred assets within the applicable lookback period as contemplated in
He-W 620; or
(5) The individual is
a medicaid applicant aged 18 through 64 who is determined by the department to
meet the standards for an expedited disability determination, presents a
completed application that indicates general and financial eligibility, and who
does not benefit from a trust or annuity and has not transferred assets within
the applicable lookback period as contemplated in He-W 620.
#5171, eff 6-26-91; EXPIRED: 6-26-99
New. #9155, eff 5-10-08
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