Current through Register No. 40, October 3, 2024
(a) "Finding of
clinical ineligibility" means any denial or termination of federal cash
benefits:
(1) Due to not meeting the medical
disability criteria; and
(2) In
response to an application, reapplication, or appeal filed for federal cash
benefits.
(b) To be
eligible for FANF or adult category financial assistance an individual shall
have applied for all potential sources of income or benefits including, but not
limited to:
(1) Benefits described under
Title XVI of the Social Security Act;
(2) Benefits described under Title II of the
Social Security Act;
(3) Veteran's
benefits, including the veteran's affairs aid and attendance
allowance;
(4) Retirement benefits
or pensions;
(5) Disability
benefits or pensions;
(6)
Unemployment or worker's compensation;
(7) Contributions from any liable
third-party; and
(8) Third-party
medical coverage.
(c)
The application for other benefits described in (b) above, shall be made:
(1) Prior to the department initiating a
determination of eligibility for the adult category financial assistance
program; or
(2) If applying for
FANF, no later than 30 days after the referral for those benefits were
made.
(d) If the
individual is incapable of applying for the aid and attendance allowance
pursuant to (b)(3) above, does not have an authorized representative to apply
on the individual's behalf, and the nursing facility will not apply on the
individual's behalf, the eligibility worker shall initiate the application for
the aid and attendance allowance on the individual's behalf.
(e) When applying for the benefits described
in (b) above, applicants and recipients of FANF or adult category financial
assistance shall:
(1) Provide all required
information and verification and complete all forms as required in the
application process for the other benefit;
(2) Cooperate in taking all necessary steps
to obtain the other income or benefit;
(3) Accept the other income or benefit if
eligible; and
(4) Pursue all appeal
options within the timeframes set by the eligibility-determining agencies or
individuals responsible for the other benefits described in (b) above, up to,
but not including, court action, if found ineligible for the benefit due to
medical reasons.
(f)
Financial assistance for the entire assistance group shall be terminated or
denied if an individual is ineligible for the other benefits described in (b)
above, due to refusal or failure to:
(1)
Complete the application process for the other benefit;
(2) Provide information or verification to
obtain the benefits described in (b) above;
(3) Cooperate with the
eligibility-determining agencies or individuals responsible for the other
benefits described in (b) above;
(4) Meet the application timeframes described
in (c) above or set by the eligibility-determining agencies or individuals
responsible for the other benefits described in (b) above;
(5) Pursue all appeal options in accordance
with (f)(2) above; or
(6) Accept
the benefit if eligible.
(g) To be eligible for APTD financial
assistance and pursuant to
RSA
167:6,VI, APTD financial
assistance applicants and recipients who have received a finding of clinical
ineligibility shall provide the department with the following:
(1) Written notification from the federal
agency which indicates the date and reason the individual was denied federal
cash benefits within:
a. Thirty calendar days
from the date of application for adult category financial assistance for any
finding of clinical ineligibility received prior to the APTD financial
assistance application, provided the finding of clinical ineligibility was made
not more than 12 months prior to the date of application; and
b. Ten calendar days from the date on the
notice of any finding of clinical ineligibility after the date of APTD
financial application; and
(2) Written notification from the federal
agency that denied the benefits which verifies that the APTD applicant or
recipient is appealing the denial or has reapplied for federal benefits within
30 calendar days of having received a finding of clinical ineligibility for
federal benefits.
(h) To
be eligible for APTD financial assistance once APTD financial assistance has
been terminated or denied due to a finding of clinical ineligibility, the
individual shall:
(1) File a new
application;
(2) Meet all APTD
program eligibility requirements; and
(3) Meet all the requirements in (i)
below.
(i) If APTD
financial benefits were terminated or denied:
(1) Due to being denied federal cash benefits
due to a finding of clinical ineligibility, the individual shall provide proof
that the individual is now approved for federal cash benefits; or
(2) Due to failure to provide notification of
clinical ineligibility decision or appeal of clinical ineligibility decision
pursuant to (g) above, the individual shall:
a. Provide all the required proof; and
b. Demonstrate via the proof
provided that the federal financial cash benefits denials and subsequent
appeals of the denials, were not due to a finding of clinical
ineligibility.
(j) If an individual is eligible for APTD
financial assistance pursuant to (h) above, APTD financial assistance shall
begin the next semi-monthly payment period following the date all the
requirements in (i) are met.
(k) To
be eligible for continued receipt of APTD financial assistance pending the
decision on the administrative appeal after an individual's APTD financial
assistance is terminated due to a finding of clinical ineligibility the
individual shall:
(1) Appeal the decision
within 10 days from the date on the notice of decision; and
(2) Provide documentation:
a. Dated and signed by a physician,
physician's assistant (PA), advanced practice registered nurse (APRN), or
psychologist which includes:
1. The printed
name of the health professional signing the documentation;
2. The specialty of the health professional;
and
3. The address and phone number
of the health professional; and
b. That states the individual's medical
condition and that the medical condition:
1.
Has increased in severity within the last 12 months; or
2. That was used when applying for or
appealing the federal benefits is unrelated to the medical condition for which
the individual applied for APTD financial assistance.
(l) Applicants denied
cash assistance due to a finding of clinical ineligibility that have not
started receiving cash benefits are not eligible for continued receipt of
benefits pending appeal pursuant to (k) above.
(m) If the department's termination of APTD
financial assistance is overturned at the appeals hearing due to the
circumstances described in (k) above, the individual shall provide the
department with written notification from the federal agency that the
individual has:
(1) Appealed the federal
denial received if the individual appealed the department's decision based on
(k)(2)b.1. above; or
(2) Reapplied
for federal benefits for the same medical condition for which the individual
applied for APTD financial assistance if the individual appealed the
department's decision based on (k)(2)b.2. above.
(n) The amount of all APTD financial
assistance provided to the individual during the pendency of the appeal is
subject to recoupment, in accordance with He-W 692, if the administrative
appeal does not find in favor of the individual.
(See Revision Note #1 at Chapter Heading He-W 600)
#5171, eff 6-26-91; amd by #5749, INTERIM, eff 12-1-93, EXPIRED: 3-31-94; amd
by #5806, eff 3-30-94; ss by #6531, INTERIM, eff 6-27-97, EXPIRED: 10-25-97; ss
by #6614, eff 10-24-97; ss by #7913, eff 6-26-03; ss by #9893, eff 6-26-11; amd
by #10374, eff 7-12-13