CHAPTER He-E 500 SOCIAL SERVICES
Statutory Authority: RSA 161:2, XII and RSA 161:4-a, III
PART He-E 501
THE SOCIAL SERVICES BLOCK GRANT
(TITLE XX)
He-E
501.01 Purpose and Goals.
(a) The purpose of this part is to describe the
requirements for services provided by the NH department of health and human
services through the social services block grant funded under Title XX of the
Social Security Act (Title XX).
(b) Title XX services shall be directed toward
one or more of the goals contained in 42 USC 1397.
Source. #5584, eff 2-16-93; ss by #5732, eff
10-27-93, EXPIRED: 10-27-99
New. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19
He-E
501.02 Definitions.
(a) “Activities of daily living (ADL)” means
activities such as grooming, toileting, eating, dressing, getting into or out
of a bed or chair, walking, and monitoring and supervision of medications.
(b) “Adult” means “adult” as defined in RSA
161-F:1, I, namely “any person 18 years of age or older.”
(c) “Adult day services” means one or more of the
following services, provided for fewer than 12 hours a day, to participants 18
years of age or older: supervision, assistance with activities of daily living,
nursing care, rehabilitation, recreation, social, cognitive, and physical
stimulation, and nutrition.
(d) “Appeal” means a request by a person
adversely affected by the NH department of health and humans service’s or a provider’s
decision or action to review that decision or action in accordance with the
provisions of RSA 126-A:5, VIII.
(e) “Authorized representative” means any adult other than a department staff member or
provider representative who is 18 years of age or older and who, with the
individual’s permission or under the authority of a guardianship order, acts on
behalf of the individual during all aspects of initial or continuing
eligibility determination for Title XX services.
(f) “Catchment area” means the geographic area
where the provider provides Title XX services, as identified in the provider’s
contract or other legal agreement with the department.
(g) “Chronic illness or disability” means that
the physical, mental, or emotional ability of a person is such that the
individual is unable to manage personal, home, or financial affairs without the
support of social services.
(h) “Commissioner” means the commissioner of the
NH department of health and human services or his or her designee.
(i) “Communication access” means, when necessary
and appropriate, providing communication assistance to individuals, who are:
(1) Non-English
speaking or have limited English proficiency;
(2)
Deaf, experiencing a degree of hearing loss, or have auditory processing
challenges;
(3) Visually
impaired; or
(4) Speech
impaired.
(j)
“Days” means days on which the department is ordinarily open for business
unless otherwise stated.
(k) “Department” means the NH department of
health and human services.
(l) “Elderly” means “elderly” as defined in RSA
161-F:1, V, namely “a person 60 years of age or older.”
(m) “Essential services” means chore, emergency
support, and respite services that are needed to maintain an individual’s
health or safety, as described in He-E 501.24.
(n) “Homebound” means that an individual is
unable to leave home without difficulty because of chronic illness or
disability.
(o)
“Home-delivered meals” means meals that
are prepared and provided to an individual in his or her home, in accordance
with He-E 501.25.
(p) “Housecleaning” means duties related to
household cleanliness including but not limited to mopping floors, vacuuming,
laundry, changing bed linens, dusting, and other tasks related to sanitation
within an individual’s living environment.
(q) “Income” means the total amount of money
received by the individual on a regular, recurring basis each month, based on
the sources of income contained in He-E 501.05.
(r) “Independent living situation” means one of
the following living arrangements:
(1) The
individual’s own home or apartment;
(2) The
home or apartment of a spouse or partner, relative, or friend where the individual
also resides;
(3) A
motel or hotel; or
(4) A homeless
shelter.
(s)
“Individual” means the adult applying for or receiving the Title XX social
services described in this part.
(t)
“In-home care” means services provided to an individual in his or her home including
the household maintenance tasks and activities of daily living described in
He-E 501.26.
(u)
“Instrumental activities of daily living” means activities performed on a
regular basis, including, but not limited to, doing laundry, cleaning, managing
money, shopping, using transportation, correspondence, making telephone calls,
obtaining and keeping appointments, socializing, and recreation.
(v) “Licensed health practitioner” means:
(1)
Medical doctor;
(2)
Physician assistant (PA);
(3)
Advanced practice registered nurse (APRN);
(4)
Doctor of osteopathy;
(5)
Doctor of naturopathic medicine; or
(6)
Any other individual with diagnostic and prescriptive powers licensed by
an appropriate NH licensing board.
(w) “Limited English proficiency” means the
inability of an individual to speak English as their primary language, and
whose skills in listening, speaking, or reading English are such that the
individual cannot adequately understand and participate in their care, or in
the services provided to them, without language assistance, the provision of
communication access services, or communication devices.
(x) “Nursing facility” means a place which
provides for 2 or more persons’ basic domiciliary services, including board,
room, and laundry, continuing health supervision under competent professional
medical and nursing direction, and continuous nursing care as may be
individually required.
(y) “Person-centered” means that the individual
or his or her authorized representative or caregiver is the center of the
system of care, and the individuals’ needs and preferences drive the care and
services provided.
(z) “Plan for achieving self- support income
(PASS)” means the Supplemental Security income or Social Security income
received by an individual, which has been designated by the Social Security
Administration to help the individual attain employment.
(aa) “Provider” means the agency under contract with
the department or enrolled as a medicaid provider of specific services or a vendor
providing Title XX services.
(ab) “Residential care facility” means a licensed
assisted living residence-residential care or assisted living-supported
residential health care licensed in accordance with RSA 151.
(ac) “Respite care” means care provided on an
intermittent basis to the eligible person to relieve the primary caregiver from
the demands of home care for a limited period of time.
(ad) “Title XX” means that section of the Social
Security Act which describes the services funded through the social services
block grant.
(ae) “Vendor” means an individual, business, or
organization reimbursed by the department for the cost of providing essential
services that are authorized by the department and described in He-E 501.24.
(af) “Wait list” means a list of individuals who
have been determined eligible, and are ready to receive, a Title XX service
from a provider, but for whom the agency does not have sufficient service units
or resources to serve the individuals.
(ag) “Without regard to income” means an
eligibility category whereby Title XX services can be provided to an individual
without regard to income, and in accordance with He-E 501.05(i).
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19
He-E
501.03 Confidentiality. All information about individuals receiving
Title XX services and programs shall be kept confidential, and only persons
involved in administering Title XX services and programs shall review an
individual’s information, unless the individual signs an authorization to
release the information to another individual or organization.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19
He-E
501.04 Title XX Services.
(a) The following Title XX services referenced in
(b) below shall be provided to individuals who meet the eligibility requirements
contained in He-E 501.05 and subject to the wait list described in He-E 501.15.
(b)
Title XX services shall include:
(1) Adult
day services;
(2) Essential
services;
(3) Home-delivered
meals; and
(4) In-home
care services.
(c) Providers of adult day services,
home-delivered meals, and in-home care shall be contracted with the department
and shall provide the services as described in this rule.
(d) Providers of essential services shall be
vendors and shall provide services as described in this rule.
(e) Eligibility for services shall be determined
by the provider, except for eligibility for essential services, which shall be
determined by the department.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19
He-E
501.05 Eligibility Requirements for
Services.
(a) In order to be eligible to receive Title XX
services an individual shall:
(1) Be
an adult as defined by He-E 501.02(b);
(2) Have
a chronic illness or disability as defined by He-E 501.02(g);
(3)
Reside in or be expected to reside in an independent living situation,
as defined by He-E 501.02(r);
(4) Have
a monthly income which does not exceed $1,512.80 per month, based on the
sources of income specified in (d) and subject to an annual cost of living
adjustment as described in (k) below;
(5) Be
in need of the requested Title XX service in order to maintain his or her
health and safety, as determined by the assessment described in (b) below;
(6) Not
already be receiving the same or duplicate services from another program such
as services under an approved medicaid waiver program;
(7) Apply
for and be found eligible to receive Title XX services as described in He-E
501.05 and 501.06; and
(8) In
order to be eligible to receive home-delivered meals, demonstrate that he or
she cannot prepare meals, and that the individual is:
a.
Homebound; or
b. Temporarily
homebound due to recovery from illness or injury.
(b) An individual’s eligibility to receive the
requested Title XX services shall be determined through an assessment as
follows:
(1) A review
of the individual’s application; and
(2) A
face-to-face interview with the individual or authorized representative, or
both, to obtain information on the individual’s ability to engage in activities
of daily living and instrumental activities of daily living.
(c) When determining eligibility for the requested
Title XX services, an individual may provide information from his or her
licensed health practitioner or other community providers to be considered as a
part of the assessment described in (b) above.
(d) When determining eligibility in accordance
with He-E 501.05 (a)(4) above, the department or the provider shall review all
sources of income including but not limited to the following:
(1)
State financial assistance;
(2)
Social Security, with the exception of PASS income;
(3) Supplemental Security income;
(4)
Veteran’s benefits;
(5)
Income received from room and board, rental of buildings or land;
(6)
Interest income received from bank accounts, estates, or trusts;
(7)
Wages or income from self-employment;
(8) Disability
benefits;
(9)
Unemployment compensation;
(10)
Worker’s compensation; and
(11)
Alimony.
(e) When determining eligibility for Title XX
services, the income of each individual, including spouses, shall be considered
separately.
(f)
If the individual receives Social
Security income and the cost of his or her Medicare premiums are not deducted
from his or her check, the amount paid
for the premiums shall be deducted from the individual’s total income for the
purposes of determining whether or not the individual meets the income requirements
in (a)(4) above.
(g) Income shall be verified for an individual in
accordance with He-E 501.06(h).
(h) Priority to receive Title XX services shall
be given to individuals who have been determined by the department to be in
need of services for protective reasons in accordance with RSA 161-F:42-57.
(i) Title XX services shall be provided without
regard to income, if the service(s) are provided during or after a protective
investigation conducted by the department in accordance with RSA 161-F:42-57.
(j)
Title XX services shall be provided to
an adult in an independent living situation.
(k) The income eligibility level in (a)(4) above
shall be subject to a cost of living adjustment, when adjusted by the social
security administration, each January by the percentage amount of the cost of
living increase in the social security benefits on a yearly basis consistent with
federal law and regulations.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19
He-E
501.06 Application Requirements and
Process.
(a) An individual or their authorized representative
shall apply to receive Title XX services via an application form provided by
the department entitled Form 3000, “Application for Social Services” (November 2019).
(b) The individual or the authorized representative
shall submit to the department or the provider depending on where the
determination of eligibility is being made, a completed Form 3000, “Application
for Social Services” certifying the following:
(1) If
the individual:
“I have read and understood the information
on the application, including the Assurances section on the next page, and I
agree that the entries I have made on this application are true and accurate to
the best of my knowledge.”
“I understand that as part of the administration
of the department programs, the department or provider may verify information I
have provided on this application and any other information that would affect my eligibility.”
“My signature below authorizes department and
provider to obtain verification and authorized release of such information to
the department and provider. My authorization to release information remains in
effect until the time of my next redetermination of eligibility.”
“I understand that I must report any change
in my address or income to the department district office or provider where I
applied for services, since such changes may affect my eligibility for
services.”
(2) If
the authorized representative:
“My signature below indicates that I have
completed this form on behalf of the applicant, using information provided by
the applicant, and that this information is true and complete to the best of my
knowledge. I have the applicant’s
permission to act on his or her behalf during all aspects of initial or
continuing eligibility for services, including compliance with the provisions
described above, and have agreed to accept the responsibilities designated to
me. I have read and understood the provisions described above and the
Assurances section on the next page. The applicant acknowledges that he/she may be
responsible for any errors, omissions or inaccurate information reported to
BEAS by me acting as the authorized representative.”
(c) If information needed to determine
eligibility, as described in He-E 501.05, is incomplete or missing, the provider
shall immediately notify the individual.
(d) The individual shall provide the missing
information to the department or the provider within 10 days of the face-to
face interview.
(e)
If the individual does not provide the missing information within the allotted time
in stipulated (d) above, the individual’s application shall be denied.
(f)
An individual shall not require an
application prior to the receiving Title XX services when the department determines
services are needed for protective reasons in accordance with RSA 161-F:42-57.
(g)
Income shall be verified as described in
(h) below and for the following reasons:
(1)
There is an indication that the income information provided by the
individual is inaccurate; or
(2) The
department performs an audit to verify income for quality control purposes.
(h) At the request of the department or the provider,
when determining eligibility, the individual or authorized representative shall
verify income by providing the following information:
(1)
Current pay stubs or employer statements, when income includes wages;
(2)
Current business records, when the applicant is self-employed;
(3) A
copy of the benefit check dated within the last 30 days or the most recent
letter from the Social Security administration, when income includes Social
Security benefits or Supplemental Security income, or a copy of the most
current bank statement showing that the Social Security or Supplemental
Security income check has been direct-deposited;
(4) A
copy of the benefit check dated within the last 30 days or the most recent
correspondence from the agency, business, or union that indicates benefit
amounts, when income includes workers’ compensation;
(5) A
copy of the pension check dated within the last 30 days or the most recent
correspondence from the appropriate agency, business, or union, when income
includes a pension;
(6)
Bank statements dated within the last 30 days, or the most recent
stockholder report when income includes interest from income, dividends,
trusts, estates, or royalties;
(7) A
copy of a check received from the tenant or boarders dated within the last 30
days or the most current copy of the rental or room and board agreement, when
income includes money received from rents, room and board, or rental of land;
(8) A
copy of the benefits check dated within the last 30 days or the most recent
notice indicating the amount of benefits awarded, when income includes
unemployment compensation;
(9) A
copy of the most recent court order or a signed statement from the individual
making the payment, when income includes alimony; and
(10) A
copy of the benefit check dated within the last 30 days or the most recent
notice indicating the amount of benefits awarded, when income includes veterans
benefits.
(i) If requested by an individual, the department
or the provider shall assist the individual with completing the application.
Source. #9849-A, eff 1-12-11, (paras (c)-(i)); #9849-B, eff1-12-11, (paras (a) and (b)); (c)-(i) EXPIRED: 1-12-19; ss by #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19
He-E
501.07 Determination, Notice of
Eligibility, and Eligibility Period.
(a)
An individual shall meet the
requirements in He-E 501.05 and 501.06 in order to be deemed eligible to
receive Title XX services.
(b) For individuals determined eligible to receive
Title XX services, the eligibility period shall be for one year, beginning on
the date that eligibility is determined, and ending 364 calendar days later.
(c) A written notice of decision shall be
provided by the department or by the provider within 45 calendar days of
receipt of an application.
(d) If the eligibility requirements are met, and
services are available, the notice shall include:
(1)
The services to be provided;
(2)
The eligibility period; and
(3)
Contact information for the department or provider, depending on which
entity is responsible for the eligibility determination.
(e) If eligibility requirements are met, but
services are not available, the individual shall be notified that his or her name
shall be placed on a wait list in accordance with He-E 501.15.
(f) If the eligibility requirements are not met,
the notice shall include:
(1)
The reason(s) for the denial;
(2) A
statement regarding the right of the individual or his or her authorized representative to request
an informal resolution or an administrative hearing, as described in He-E 501.11
501.12 respectively; and
(3)
Contact information for the department staff member or provider
depending on which entity is responsible for the eligibility determination.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19
He-E
501.08 Individual’s Responsibility To
Report Changes.
(a) The individual receiving services or on a
wait list shall be responsible for reporting to the department or to the provider
any changes in circumstances that could affect his or her eligibility for Title
XX services, including changes in:
(1)
Address;
(2) Type
of living arrangement;
(3)
Sources and amounts of income; and
(4) The individual’s level of functioning
that would have a direct effect on the need for services.
(b) When the individual reports changes described
in (a) above, the department or the provider shall determine whether these
changes affect the individual’s eligibility for Title XX services, based on the
requirements described in He-E 501.05.
(c) When the individual level of functioning has
changed as described in (a)(4) above, the department or the provider shall
verify the changes via the redetermination process outlined in He-E 501.09 and,
either:
(1)
Have a face-to-face meeting with the individual; or
(2) Accept documentation from the
individual’s licensed health practitioner describing the change in the
individual’s level of functioning.
(d) If it is determined that the reported changes
cause the individual to become ineligible for Title XX services:
(1) Services
shall be terminated and a notice shall be sent to the individual in accordance
with He-E 501.10(c); or (2) The individual
shall be removed from the wait list and provided notice in accordance with He-E
501.15.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19
He-E
501.09 Redetermination of Service
Eligibility.
(a)
The department or the provider shall provide the application entitled Form 3000
“Application for Social Services” (November 2019) to the individual 60 days
prior to the end of the eligibility period.
(b) At least 45 calendar days prior to the end
date of the individual’s eligibility period, the individual shall complete and
submit the application referenced in (a) above for redetermination of
eligibility.
(c) If requested by an individual, the department
or provider staff shall assist the individual with completing the application
during a scheduled visit.
(d) The department or the provider shall:
(1) Re-determine eligibility in accordance
with He-E 501.05; and
(2)
Send notice to the individual or his or her authorized representative,
as described in He-E 501.07, confirming whether the individual continues to be
eligible for Title XX services and:
a. If
the individual is determined eligible to continue receiving Title XX services,
services shall be authorized in accordance with He-E 501.16; or
b. If
the individual is determined ineligible to receive Title XX services, services
shall be discontinued in accordance with He-E 501.10.
(e) If an individual does not submit the
application prior to the end of their eligibility period services shall be terminated
in accordance with He-E 501.10, subject
to the right of appeal or informal resolution as described in He-E 501.12, and
until such time that the individual re-applies and is found eligible for Title
XX services in accordance with He-E 501.06.
Source. #9849-A, eff 1-12-11, (paras (c)-(f)); #9849-B,
eff
1-12-11, (paras (a) and (b)); (c)-(f) EXPIRED: 1-12-19; ss by #12720,
INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19
He-E 501.10 Termination of Services.
(a)
Title XX services shall be terminated when:
(1) The individual or his or her authorized
representative requests that the services be terminated;
(2) The individual no longer meets the
eligibility requirements for Title XX services as described in He-E 501.05;
(3) Funding for the service(s) is no longer
available;
(4) The individual did not reapply for services
in accordance with He-E 501.09;
(5) The individual relocates to a geographic area
outside the catchment area area;
(6) The individual relocates to an institutional
setting excluding short-term respite care; or
(7) The individual dies.
(b) If a provider wishes to terminate services
for an eligible individual because the provider determines that the individual’s
behavior or living environment creates a health or safety hazard for the provider’s
staff, then:
(1) The provider shall initiate an adult
protective report in accordance with RSA 161-F: 46 and He-E 700;
(2) If the provider wishes to terminate Title XX
services for the reason described in (b) above, the provider shall:
a. Forward to the department a written
notification of the reasons for terminating services, including a summary of
the efforts the provider has made to resolve the situation;
b. Consult with department staff for assistance
in determining possible remedies other than termination;
c. Following consultation with department staff,
document and report to the department the outcome of each additional effort
made to resolve the situation;
d. Notify the department of a final decision to
terminate prior to distribution of the notice to the individual; and
e. For individuals whose services are terminated
in accordance with (a) above, document in the individual’s service record a description
of the individual’s behavior(s) or living environment that created a health or
safety hazard for the provider’s staff, as well as the provider’s attempts to
continue to provide services; and
(3) The provider shall send written notice to an
individual as specified in He-E 501.10(c) below, within 5 business days of
notifying the department as indicated in He-E 501.10(b)2.d.
(c)
The notice of termination of services shall specify:
(1) The service(s) to be terminated;
(2) The reason(s) for terminating the service or
services;
(3) The date upon which the service(s) shall be
terminated, which shall be 30 days from the date of the notice;
(4) A statement that the individual has 30
calendar days from the date of the notice to request an administrative hearing with
the department as described in He-E 501.11 and in accordance with He-C 200; and
(5) The contact information for the department or
provider staff member who completed the notice.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19
He-E
501.11 Informal Resolution.
(a)
An individual who disagrees with an eligibility determination,
redetermination, or termination of Title XX services may request an informal
resolution of the decision, as follows:
(1)
The individual or his or her authorized representative, shall submit a
written request to the department within 30 calendar days of the eligibility or
termination determination; and
(2)
The written request shall include:
a. An explanation of the reason why the decision
on the eligibility determination, redetermination or termination determination should
be changed; and
b. Any supporting documentation.
(b)
For individuals currently receiving services, Title XX
services shall continue during the informal resolution process until a decision is rendered.
(c)
The department shall review the request in (a) above and provide a
written notice within 45 days to the individual, or his or her authorized
representative, of the decision to maintain or change the original eligibility
or termination decision, including the reason therefor. The Department shall
make a redetermination based on the same criteria used in the initial determination
and shall take into consideration any new information.
(d)
If the department or provider’s decision is not
upheld:
(1)
Services shall be initiated for individuals requesting services; and
(2)
Services for individuals currently receiving Title XX services shall continue
as long as the Title XX eligibility requirements described in He-E 501.05 are
met or until the end of the individual’s eligibility period.
(e) If the department’s or provider’s
decision is upheld, services for individuals currently receiving services shall
end within 30 calendar days of the decision.
(f) Requesting an informal resolution shall not:
(1)
Preclude in any way an individual’s right to appeal a disputed
eligibility or termination determination in accordance with He-C 200; or
(2) Change
the timeframes established for filing an appeal.
(g) An individual may appeal the decision of the department
in accordance with He-C 200 and RSA 541-A:29.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19
He-E
501.12 Administrative Hearing and
Provisions of Services During the Administrative Appeal Process.
(a) An individual or his or her authorized
representative wishing to appeal a decision made during the service eligibility
determination or redetermination may request an administrative hearing within
30 calendar days of receiving the written notice of decision described in He-E
501.07 or He-E 501.10.
(b) The request for an appeal shall be submitted
in writing and addressed to:
Department of Health & Human Services
Administrative Appeals Unit
105 Pleasant St., Concord, NH 03301
(c) The hearing shall be conducted in accordance
with RSA 541-A and He-C 200.
(d) If the individual or his or her authorized representative
requests an administrative hearing for the termination of Title XX services as
described in He-E 501.10, Title XX services shall continue until a decision is
rendered.
(e) If the department’s or provider’s decision is
not upheld, the individual shall continue to receive services as long as the
Title XX eligibility requirements described in He-E 501.05 are met or until the
end of the individual’s eligibility period.
(f) If services were discontinued in accordance
with He-E 501.10(b), and the provider’s decision is not upheld, a provider
shall initiate services within 30 days of the date on the notice decision.
(g) If the department’s decision is upheld:
(1)
The individual shall be notified in accordance with He-C 200; and
(2) Title
XX services shall end within 30 calendar days of the hearing officer’s notice
of decision.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19 (formerly He-E 501.11)
He-E 501.13 Provider Requirements.
(a) Providers wishing to provide adult day
services, home-delivered meals or in-home care shall be under contract with the
department to provide such service(s).
(b) Providers shall:
(1)
Comply with all provisions included in the contract with the department;
(2) Comply with and make available upon
request any licensing or certification requirements required by applicable
federal, state, or local laws or rules,
specifically:
a. For
providers providing in-home care, be licensed as a home health provider, home
care service provider, or other qualified agency in accordance with He-P 809
and He-P 822, respectively; and
b. For
providers providing adult day services, be licensed as an adult day program in
accordance with He-P 818;
(3)
Develop person-centered plans as described in He-E 501.22;
(4)
Determine eligibility for applicants and comply with notice requirements
as described in these rules;
(5)
Maintain the insurance coverage required by applicable state or local laws
or rules, and provide written proof of such insurance coverage to the
department;
(6)
Identify an executive director who will oversee the services being provided;
(7)
Identify staff who will complete the responsibilities contained in this
rule for the service(s) being provided;
(8)
Train and supervise provider staff and volunteers regarding the
following:
a. The
provider’s policies and procedures;
b. The
specific Title XX services the staff or volunteer will be providing; and
c. Any
additional training requirements contained in applicable federal or state
laws/rules;
(9) Comply
with all contract requirements regarding the provision of communication access
to individuals who are requesting or receiving services covered under this
rule;
(10) Develop protocols for staff responses to
emergencies;
(11)
Develop protocols for reporting suspected abuse, neglect, self-neglect,
or exploitation of incapacitated adults as required by RSA 161-F: 46 of the
adult protection law;
(12)
Comply with the provisions of RSA 161-F: 49 with regard to checking the
names of prospective or current employees, volunteers or subcontractors against
the state registry administered by the department’s bureau of elderly and adult
services;
(13) Have
an established written complaint and incident process that may be accessed by
individuals, family members, or authorized representative when an individual is
denied services or dissatisfied with the services provided by the provider,
including:
a. The
name or position of the provider’s staff member who coordinates the complaint
and incident process;
b. The
issues that may be addressed through the complaint and incident process;
c. How
individuals are informed of their right to file a complaint or incident report;
d. The
procedures to be followed by individuals who wish to file a complaint or
incident report with the provider;
e. The
procedures to be followed by the provider when reviewing complaints or
incidents, and for notifying the individual of the outcome of the review; and
f.
Information stating that the availability of the complaint and incident
process from the provider shall not cancel the right of an individual who is
denied Title XX services to request an administrative hearing in accordance
with He-E 501.12 and He-C 200;
(14)
When requested, provide information to the department regarding
individuals receiving services;
(15)
Maintain financial records;
(16)
Maintain service records in accordance with He-E 501.17 for the specific
Title XX service provided per eligibility period;
(17) Submit the fiscal reports required by
the department pursuant to the provider contract;
(18)
Submit information on the wait list in accordance with He-E 501.15;
(19)
Engage in monitoring and evaluating the quality of the services being
provided, which shall include:
a.
Obtaining feedback from the individual, authorized representative, and
family members;
b.
Participating in any quality assurance measures implemented by the department;
and
c. Making
changes as necessary to improve the quality and effectiveness of service
delivery; and
(20) When
providing home-delivered meals service:
a. Be
in compliance with federal, state, and local regulations for food safety, meal
preparation and delivery;
b. Employ staff or subcontract with another
agency to prepare and deliver meals;
c.
Demonstrate on a quarterly basis that meals are in compliance with the nutritional
requirements contained in He-E 501.25 by
providing the department with sample menus which are signed by a registered
dietitian or another professional with comparable expertise;
d.
Ensure that meals are delivered only when individuals are at home to
receive them;
e. Ensure that the driver who delivers meals
has face-to-face contact with each individual; and
f. Keep a record of the number of meals
authorized for the individual and the scheduled days of delivery.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19 (formerly He-E 501.20)
He-E 501.14 Fees for Title XX Services.
(a) Providers providing Title XX services may charge fees to individuals
receiving these services under the conditions described in this section.
(b) Providers that elect to charge fees shall:
(1) Develop a sliding fee schedule;
(2)
Provide the fee schedule to individuals in a
letter that describes:
a. The
basis for the fee;
b. A
description of the program the fee is being applied to;
c. A
description of how the fee applies based on the individual’s income;
d. The
billing schedule, as applicable; and
e.
Whether or not and when services would be discontinued for non-payment;
and
(3) Include with the letter to the individual, in (2) above, a copy of
the sliding fee schedule.
(c) Providers shall base sliding fee schedules on the following
considerations:
(1)
The type of program(s) the fee is being applied to;
(2)
The ability of the individual to pay the fee which includes the income of
the individual receiving Title XX services; and
(3)
The fee does not exceed the difference between the amount reimbursed by
the department to providers and the standard payment charged to individuals
paying privately for the full cost of services provided
by the provider.
(d) Providers shall:
(1)
Communicate the fee schedule verbally and in writing prior to commencing
services; and
(2)
Make available fee and billing information at
any time.
(e) No fees shall be charged to the client receiving
Title XX services when the department has determined that services are
needed for protective reasons in accordance with RSA 161-F:42-57.
Source. #9849-A, eff
1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19 (formerly He-E 501.13)
He-E 501.15 Wait Lists.
(a)
All services covered by He-E 501 shall be provided to the extent that
funds, staff or resources for this purpose are available.
(b)
The provider shall maintain a wait list when funding
or resources are not available to provide the requested services for:
(1)
Individuals who:
a. Are
newly eligible; and
b. Are
ready to receive services;
(2)
Individuals who:
a. Are
receiving services; and
b.
Requesting additional services; or
(3)
Individuals who:
a.
Relocate outside of the catchment area for the contact agency providing
services; and
b. Are
requesting Title XX services from a provider in the new location in accordance
with He-E 501.19.
(c)
Each provider shall include the following information on
its wait list:
(1)
The individual’s full name and date of birth;
(2)
The name of the Title XX service being requested;
(3)
The date upon which the individual applied for services which shall be
the date the application was received by the provider or by the department;
(4) The target date of implementing the services
based on the communication between the individual and the department or provider;
(5)
The date upon which the individual’s name was placed on the wait list
shall be the date of the notice of decision in which the individual was
determined eligible for Title XX services;
(6)
The individual’s assigned priority on the wait list, determined in
accordance with (d) below;
(7) A
brief description of the individual’s circumstances and the services he or she
needs; and
(8) If
the individual is already receiving a Title XX service, the type and amount of
the services received.
(d)
The provider shall prioritize each individual’s standing on the list by
determining the individual’s urgency of need in the following order:
(1) The
individual is at risk of being admitted to an institutional setting;
(2)
The individual is discharged from an institutional setting;
(3)
Declining mental or physical health of the caregiver;
(4)
Declining mental or physical health of the individual;
(5) The
individual has no respite services while living with a caregiver; and
(6)
Length of time on the wait list.
(e)
When 2 or more individuals on the wait list have been assigned the same
service priority, the individual served first will be the one with the earliest
application date.
(f)
Individuals with adult protective needs in accordance with RSA
161-F:42-57 shall be exempt from the wait list.
(g) The individual may reserve the
right to remove his or her name from the wait list at anytime or apply for
Title XX services with another provider.
(h)
When an individual is placed on the wait list, the provider shall notify
the individual in writing and include the following information:
(1) A
statement that Title XX services are not covered because funds, staff, or
resources are unavailable;
(2) A
brief description of the provider’s wait list process;
(3) The
estimated period of time that the provider expects the individual to remain on
the wait list;
(4) A statement that notifies the individual
of the right to remove his or her name from the wait list and to apply for
Title XX services with another provider;
(5) A
statement that directs the individual to the specified toll-free telephone
number to NH ServiceLink for more information on other providers in the
individual’s catchment area that provide the Title XX service being
requested;
(6)
The contact information for the provider; and
(7) A statement
requesting that the individual notify the agency if his or her service needs
change or if the individual begins to receive the requested Title XX service
from another provider.
(i)
Immediately upon becoming aware of availability to provide a Title XX
service, the provider shall call and send written notice to the individual
requesting Title XX services based on the priority outline in (f) above.
(j)
The individual shall respond to the provider within 10 days of the date
on the written notice, indicating whether or not her or she still wishes to
receive the Title XX services.
(k) If the individual does not respond
within 10 business days, the provider shall no longer be obligated to guarantee
Title XX services to that individual.
(l) The individual may reapply to
receive Title XX services in accordance with He-E 501.05.
(m)
If an individual is found ineligible due to a reported change in circumstances
as described in He-E 501.08, the department or the provider shall remove the
individual from the wait list and provide notice to the individual that includes
the following information:
(1)
The individual has been removed from the wait list;
(2) The individual has 30 calendar days from
the date of the notice to request an administrative hearing as described in
He-E 501.12 and in accordance with He-C 200 and RSA 541-A:29 unless the
provisions conflict with the Title XX federal requirements ; and
(3)
The contact information for the department or provider staff member who
completed the notice.
Source. #9849-A, eff 1-12-11, (paras (b)-(c));#9849-B, eff
1-12-11, (para (a)); (b)-(c) EXPIRED: 1-12-19; ss by #12720, INTERIM, eff
1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19 (formerly He-E 501.14)
He-E
501.16 Service Authorization.
(a) Once
an applicant has been determined eligible to receive Title XX services, one or
more of the following services shall be authorized by the provider based on the
needs identified in the individual’s person-centered plan:
(1) Adult
day services;
(2) Home-delivered
meals; and
(3) In-home
care services.
(b) The provider
shall complete Form 3502, “Contract Service Authorization-New Authorization” (November
2019) and submit to:
Department of Health and Human Services
Bureau of Data Management
129 Pleasant Street
Concord, NH 03301
(c) Payment
shall not be made to the provider unless Form 3502, “Contract Service
Authorization” (September 2014) is submitted to data management as indicated
above.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19 (formerly He-E 501.15)
He-E
501.17 Service Records.
(a)
Providers
shall maintain service records for all individuals receiving Title XX services.
(b) The service
record shall contain:
(1) The
individual’s name, address, and telephone number;
(2)
The name, address, and telephone number of the individual’s primary
caregiver;
(3)
The name and telephone number of a person who may be contacted in an
emergency;
(4) Documentation
of the individual’s communication access needs, including modality, and the
name of the communication access provider or type of device utilized, if
applicable;
(5) The
name and telephone number of the individual’s licensed health practitioner, if
applicable;
(6) The
name and contact information for the pharmacy used by the individual, if applicable;
(7) The
application described in He-E 501.06;
(8) The
notice of decision described in He-E 501.07;
(9) The
service authorization form required by He-E 501.16;
(10) The
person-centered plan as described in He-E 501.22;
(11) Copies
of correspondence related to service provision; and
(12) Documentation
of the following:
a. The
name of the Title XX service being provided, and the type of service
activities, based on the service description contained in this rule;
b. The
dates of service provision and other related contacts with the individual;
c. Changes in the individual’s health or
other circumstances affecting service provision;
d. Any
other information or correspondence deemed relevant to service provision; and
e.
Documentation of any referrals made to other resources or programs.
(c) Service records shall be kept confidential in
accordance with He-E 501.03 and all applicable federal and state laws, rules, or regulations.
(d)
Service
records shall be retained for a period of 4 years after services have ended or
been terminated.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19 (formerly He-E 501.16)
He-E
501.18 Title XX Services Added During the
Eligibility Period.
(a) Additional
Title XX services may be authorized for an eligible individual at any time
within the eligibility period.
(b) If, after the initial service authorization,
the individual or his or her authorized representative requests another Title XX service or services
in addition to the service(s) previously authorized, the department or provider
shall:
(1) Confirm that the individual continues to
meet the Title XX eligibility requirements as described in He-E 501.05;
(2) Document on the original application form
that another Title XX service(s) is/are being added, and request that the
individual initial this note within 30 calendar days in order to confirm that
he or she is requesting the service; and
(3)
Follow the procedures for service authorization that are described in
He-E 501.16.
(c) Additional Title XX services added in
accordance with this part shall have the same eligibility period end date as the
first service the individual was found eligible to receive.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19 (formerly He-E 501.17)
He-E
501.19 Relocation and Title XX
Services.
(a)
When an individual receiving Title XX services
relocates to a new location outside the provider’s catchment area, the provider shall refer the
individual to another provider to make arrangements to receive Title XX
services in the new location unless the provider and the individual agree to
continue Title XX services after the individual has relocated to another
catchment area.
(b) The
provider shall transfer the individual’s service record to the provider in the
new location.
(c) Within 20 days of an individual’s relocation
to another catchment area, a provider shall provide notification to the
department that it is no longer providing Title XX services to the individual.
(d) The
provider providing Title XX services in the new location shall conduct a record
review.
(e) An individual’s eligibility period end date
shall not change when an individual relocates to another provider.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19 (formerly He-E 501.18)
He-E 501.20 Cessation of Title XX Services by a Provider.
(a) When a provider decides to stop
providing Title XX services, the provider shall provide written notification to
the department according to the
terms of the contract.
(b)
The provider shall notify individuals receiving Title XX services of the
date upon which services will cease, and
what kind of assistance the agency plans to provide during the transition.
(c) The
provider shall also comply with any other provisions contained in its contract with
respect to the cessation of Title XX services.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19 (formerly He-E 501.19)
He-E 501.21 Vendor
Requirements.
(a) Vendors
wishing to provide the essential services described in He-E 501.24 shall:
(1) Comply with any licensing or certification
requirements required by applicable federal, state, or local laws , rules or
regulations, and provide copies of any current licenses and certificates to the
department;
(2) Have a tax identification number;
(3) Obtain any permits, as applicable, prior to
the service being rendered;
(4) Have proof of insurance; and
(5) Provide essential services in accordance with
the authorization issued in accordance with (b) below.
(b) Essential services shall be authorized by the
department and take into consideration the following:
(1)
The individual’s needs for the specific essential service being requested; and
(2)
The cost of the service being provided by the vendors, based on the vendor’s written
estimate.
(c)
Vendors offering to provide essential services shall provide a written
estimate on the cost thereof, which shall be authorized by the department prior to services being provided.
(d)
Vendors providing emergency
support shall:
(1) Be reimbursed for no more than the actual
costs of the goods purchased and services rendered; and
(2) Include with the invoice a receipt(s) for the
goods purchased.
(e)
Vendors providing essential services to an individual shall be reimbursed
based on the dollar amount authorized
by the department which shall not exceed the amounts stipulated in (1)-(3)
below:
(1) $500 per individual for chore service during
the eligibility period;
(2) $1000 per individual for emergency support provided
during the eligibility period; or
(3) $294 per individual for respite care provided
during eligibility period.
(f)
The vendor shall not bill the individual for any amount for essential
services.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19
He-E
501.22 Person-Centered Plan.
(a) Providers providing adult day services, home
delivered meals, and in-home care services shall develop with input from each
individual or his or her authorized representative a person-centered plan to
drive the provision of Title XX services.
(b)
The person-centered plan shall be based on the individual’s needs and developed
with input from the individual or his or her authorized representative so that
services are designed, scheduled, and delivered to best meet the needs and
preferences of the individual, and so that the individual is supported as a
full participant in the service planning and decision-making process.
(c) The person-centered plan shall include:
(1)
Identification of the anticipated needs, goals, and outcomes of service
provision from the perspective of the individual;
(2) Written
acknowledgement that the person-centered plan was developed with input from the
individual or his or her authorized representative;
(3) Written
acknowledgement that, as appropriate, reflects the person-centered plan is
responsive to the changing needs of the individual; and
(4) Information on the individual’s health
condition, medications, allergies, and special nutritional needs as appropriate
to the service being provided to assess the individual’s service needs and to
coordinate service.
(d) The provider shall provide service to the
individual based on the person-centered plan. In addition to the requirements in (c) above,
providers of adult day services shall be required to comply with all care plan
requirements described in He-P 818.
(e) The person-centered plan shall be updated
annually and whenever there is a change in the individual’s living arrangement
or health status, or a change requested by the individual and agreed to by the
involved parties.
(f) In addition to the requirements in (c) above,
for individuals receiving home-delivered meals, the person-centered plan shall
include:
(1)
The number of meals to be delivered and when the meals are to be
delivered;
(2)
Documentation of any other special needs or factors that could impact
service provision; and
(3)
Consideration of the individual’s nutritional needs, including to the
extent possible, any special nutritional needs and preferences.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19 (formerly He-E 501.21)
He-E
501.23 Adult Day Services.
(a) Adult day services shall include the following
activities, based on the individual’s needs:
(1) Supervision in a protected environment;
(2)
The following services, as described in He-P 818.15:
a.
Personal care services;
b.
Health and safety services;
c. Nutrition
services;
d.
Nursing services;
e. Social
services; and
f.
Recreational activities;
(3) Monitoring
of the individual’s condition and counseling, as appropriate, on nutrition,
hygiene, or other related matters; and
(4) Referrals,
as appropriate, to other services and resources that could assist the
individual, including any necessary follow-up.
(b) Providers of adult day services shall:
(1) Be
licensed and comply with all duties and responsibilities of licensees as required
in He-P 818;
(2) Provide
the required services described in He-P 818; and
(3) Maintain
records as described in He-P 818.
(c) In order for an individual to be eligible to
receive adult day services, the individual’s licensed practitioner shall:
(1) Complete
a physical examination on the individual within 60 calendar days prior to the
request for services; and
(2) Refer
the individual for adult day services, because the individual:
a. Has
been diagnosed as having an illness or disability; and
b. Requires
adult day program services.
(d) Adult day services funded under Title XX shall
not be available to anyone:
(1) Who
resides in a nursing facility or other licensed or certified facility;
(2) Who
receives adult family care services pursuant to He-E 801.14;
(3) Whose
needs cannot be met by adult day services; or
(4) Who
is primarily seeking services to support needs related to a diagnosis of mental
illness or developmental disability.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19 (formerly He-E 501.22)
He-E
501.24 Essential Services.
(a) Essential services shall include one or more
of the following components, depending on the individual’s needs as identified
by the department in accordance with He-E 501.05:
(1) Chore
services, including but not limited to, home maintenance or repairs, heavy cleaning,
fumigation, snowplowing, and trash removal;
(2) Emergency
support, including but not limited to, payment for food, shelter, clothing,
medicine, home heat, or telephone installation; and
(3) Respite
care, when the individual needs assistance in the absence of his or her primary
caregiver, or when the individual needs interim care while in transition to
another living arrangement, and to include one or more of the following based
on the individual’s needs:
a. Meal
preparation;
b. Personal
care; or
c. Light
housekeeping.
(b) Respite care may be provided to the
individual in the private home or in a licensed residential care or nursing
facility.
(c) Vendors shall comply with the authorization
described in He-E 501.16, which shall include the amount of funds authorized
for chore, emergency support, or respite services based on the requirements
contained in He-E 501.21.
(d) Individuals receiving essential services
shall receive follow up from the department to:
(1) Confirm
that services are being provided as authorized; and
(2) Provide
assistance if there are any outstanding issues.
(e) Essential services funding shall not be
authorized to supplement services being funded through another Source.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19 (formerly He-E 501.27)
He-E
501.25 Home-Delivered Meals.
(a)
Home-delivered meals services shall
include:
(1)
The delivery of nutritionally balanced meals, based on the requirements
contained in (c) and (d) below, to the individual’s home;
(2) The monitoring of the individual and the
reporting of emergencies, crises, or potentially harmful situations to
emergency personnel;
(3) The
distribution of educational materials on nutrition and wellness, including, but
not limited to, the following:
a.
Printed materials available at no cost from federal, state, or local
government sources or from other agencies; or
b.
Information provided by the provider through another venue, such as a
newsletter; and
(4)
Referrals as necessary to other services or programs.
(b) Home-delivered meals shall be provided to individuals
who:
(1) Meet
the eligibility requirements contained in He-E 501.05;
(2) Can
demonstrate that they cannot prepare meals without assistance; and
(3) Are
homebound or temporarily homebound due to recovery from illness or injury.
(c)
Providers providing home-delivered meals
shall:
(1) Comply
with state and local regulations on the safe and sanitary handling of food,
equipment and supplies used in the storage, preparation, service and delivery
of meals as described in He-P 2300;
(2) Accommodate,
to the extent possible, the special nutritional needs or preferences of the
individual, including recommendations from the individuals’ licensed
practitioner;
(3) Confirm
that the individual is physically present to receive the meal; and
(4) Not
be reimbursed for meals that are delivered when the individual is not at home.
(d)
Each meal shall:
(1) Include at
least one-third of the dietary reference intakes based on age and gender, established by the U. S. Department
of Agriculture for dietary reference intakes as specified in the United States
Department of Agriculture’s “Dietary Guidelines for Americans 2015-2020” (Eighth
Edition), available as noted in Appendix A; and
(2) Meet the U.S. Department of Agriculture recommended
Dietary Guidelines for Americans as specified in the United States Department of Agriculture’s
“Dietary Guidelines for Americans 2015-2020” (Eighth Edition),b incorporated in
(1) above and available as noted in Appendix A.
(e)
At least 3 times per year, the provider of
home-delivered meals shall distribute to all individuals receiving
home-delivered meals educational materials on nutrition and wellness,
including, but not limited to, the following:
(1) Printed
materials available at no cost from federal, state, or local government sources
or from other agencies; or
(2) Information
provided by the provider through another venue, such as a newsletter.
(f)
As necessary, the provider shall refer
individuals to other services or programs.
(g) Providers providing home-delivered meals
shall keep a service provision record of all meals delivered that includes:
(1) The
date of the meal;
(2) The
name of the person the meal was delivered to; and
(3) Comments
on any follow-up service provided or referrals to other services.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19
He-E
501.26 In-Home Care Services.
(a) In-home care services, also known as adult
in-home care, shall include the following core household maintenance tasks
based on the individual’s needs including:
(1) Light
housecleaning;
(2) Laundry;
(3) Maintaining
a safe environment in areas of the home used by the individual;
(4) Meal
preparation for the individual only and not for other members of the household;
(5) Rearranging
light-weight furniture to assure the individual can safely ambulate to reach
food, water, medication, and other essential items;
(6) Shopping
for groceries and performing other errands for the individual receiving
services; and
(7) Instructing
the individual to perform core household maintenance tasks necessary to
maintain the individual’s well-being, safety, and independence.
(b)
In-home care services shall also include
the following:
(1) Assistance
with one or more of the following ADLs or instruction in self-care, based on
the individual’s needs:
a. dressing;
b. meal
preparation, eating and drinking;
c. grooming;
d. assistance
with medication as allowed by He-P 809 and He-P 822; and
e. toileting;
(2) Providing
and encouraging socialization; and
(3) Evaluating
the individual’s progress and, when necessary, providing information about and
referral to other resources.
(c) In-home care services shall be provided by
employees of:
(1) Home
health care providers licensed in accordance with RSA 151:2 and He-P 809; and
(2) Home
care providers licensed in accordance with RSA 151:2 and He-P 822.He-E 501.27.
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19 (formerly He-E 501.24)
He-E
501.27 Waivers.
(a)
A provider may request a waiver of a requirement(s) contained in He-E
501 by sending a letter to the department on the provider’s letterhead, and shall submit the request to the attention of the department
by:
(1) Email
to beas@dhhs.nh.gov; or
(2) Fax
to (603) 271-4643; or
(3)
Mail to:
The Department of Health & Human Services
Bureau of Elderly and Adult Services
105 Pleasant St., Main Building
Concord NH
03301.
(b) The waiver request shall be signed by the provider’s
executive director or designee, and shall include:
(1) The
specific requirement(s) in He-E 501 that the provider requests to have waived;
(2) The
reason why the waiver is being sought; and
(3) The
alternative proposed by the provider to satisfy the requirements of He-E 501.
(c) The department shall review the request, and
within 30 calendar days of the date the request was received, determine whether
or not to approve it.
(d) The waiver request shall be approved if the
alternative proposed by the provider meets the objective or intent of He-E 501,
and, in the opinion of the department, the waiver:
(1) Shall
not negatively impact the health or safety of the individual(s);
(2) Shall
not affect the quality of services provided to individuals by the provider; and
(3)
Shall not waive any provision or procedure prescribed by statute.
(e) The department shall inform the provider in
writing of the decision on the waiver request.
(f)
Waivers
that are approved shall become effective as of the date of the written notice
referred to in (e) above, and shall not expire except as follows:
(1) Those
waivers which relate to the health, safety, or welfare of individuals and
require periodic reassessment shall be effective for one calendar year only
subject to the participant’s continued eligibility; and
(2) Any waiver shall end with the closure of the related program or
service.
(g) The provider may request a renewal of a
waiver from the department, and such a request shall be made at least 90
calendar days prior to the expiration of a current waiver and following the
steps described in He-E 501.28(a)-(e).
(h)
The request to renew a waiver shall be
granted based on the requirements stipulated in He-E 501.23(d).
Source. #9849-A, eff 1-12-11, EXPIRED: 1-12-19
New. #12720, INTERIM, eff 1-29-19, EXPIRED: 7-29-19
New. #12936, eff 12-7-19
PART He-E 502
OLDER AMERICANS ACT SERVICES:
TITLE IIIB – SUPPORTIVE SERVICES, TITLE IIIC1 AND C2 – NUTRITION PROGRAM
POLICIES, AND TITLE IIID – DISEASE PREVENTION AND HEALTH PROMOTION SERVICES
REVISION NOTE:
Document #10530, effective 2-28-14, adopted He-E 502 titled
“Older Americans Act Services: Title
IIIB-Supportive Services, Title IIIC1 and C2-Nutrition Program Policies, and
Title IIID-Disease Prevention and Health Promotion Services.” He-E 502 had formerly been titled “Definitions”
for Chapter He-E 500 on social services.
The former He-E 502 had originally been filed under Document #5584,
effective 2-16-93, had been superseded by rules filed under Document #5732,
effective 10-27-93, and had expired 10-27-99.
He-E 502.01 Purpose and Goals.
(a)
The purpose of the rule is to describe:
(1) The services
administered by the NH department of health and human services (DHHS), bureau
of elderly and adult services (BEAS) through the Older Americans Act (Title
III) to those individuals who meet the eligibility requirements contained in
these rules; and
(2) The
eligibility requirements for these services.
(b) In
accordance with the Older Americans Act, Title III services shall be directed
toward one or more of the goals contained in 45 CFR 1321 and 42 U.S.C.
3001, with emphasis placed on serving the following groups of individuals:
(1) Individuals with severe disabilities;
(2) Low income minority older individuals;
(3) Native Americans;
(4) Older individuals in greatest social or
economic need;
(5) Older individuals residing in rural areas;
(6) Older individuals with limited English proficiency; and
(7)
Older individuals at risk for institutional placement.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.02
Definitions.
(a)
“Activities of daily living (ADLs)” means activities such as grooming,
toileting, eating, dressing, getting into or out of a bed or chair, walking,
and monitoring and supervision of medications.
(b)
“Adult” means “adult” as defined in RSA 161-F:1, I, namely “any person
18 years of age or older.”
(c)
“Adult protective services (APS) program” means the program which
encompasses all the tasks and responsibilities completed in accordance with the adult protection law, RSA
161-F:42-57.
(d)
“Appeal” means a request by a person adversely affected by the NH
department of health and human service’s or contract agency’s decision or
action to review that decision or action in accordance with the provisions of
RSA 126-A:5, VIII.
(e)
“Authorized representative” means any adult
other than a bureau of elderly and adult services staff member or contract
agency representative who is 18 years of age or older, and who, with the
individual’s permission, acts on behalf of the individual during all aspects of
initial or continuing eligibility determination for Title III services or under
the authority of a guardianship order.
(f)
“Bureau of elderly and adult services (BEAS)” means the
(g)
“Catchment area” means the geographic area where the contract agency
provides Title III services, as identified in the agency’s contract with
(h)
“Communication access” means, when necessary and appropriate, providing
communication assistance to individuals, who are:
(1)
Non-English speaking or have limited English proficiency;
(2)
Deaf, experiencing a degree of hearing loss, or have auditory processing
challenges;
(3)
Visually impaired; or
(4)
Speech impaired.
(i)
“Contract agency” means the agency under contract with
(j)
“Donation” means a voluntary contribution made by an individual
receiving Title III services that is used to support the cost of these
services.
(k) “Evidence-based”
means that a program or intervention has been published in a peer-review
journal and demonstrated through evaluation to be effective for improving the
health and well-being or reducing disease, disability or injury among older individuals.
(l)
“Federal poverty guidelines” means the poverty guidelines updated periodically
in the Federal Register by the U.S. Department of Health and Human
Services under the authority of 42 U.S.C. 9902(2).
(m)
“Greatest economic need,” as defined by the Older Americans Act, means
the financial need resulting from an income at or below the federal poverty
guidelines.
(n)
“Greatest social need,” as defined in the Older Americans Act, means the
need caused by non-economic factors, which include physical and mental
disabilities, language barriers, and cultural, social, or geographical
isolation, including isolation caused by racial or ethnic status that restricts
the ability of an individual to perform normal daily tasks or threatens the
ability of the individual to live independently.
(o) “Group educational service/activity”
means an event or meeting during which educational or informational material is
presented to a group of 2 or more individuals.
(p) “Housecleaning” means duties related to
household cleanliness including, but not limited to, mopping floors, vacuuming,
laundry, changing bed linens, dusting, and other tasks related to sanitation
within an individual’s living environment.
(q)
“Independent living situation” means one of the following living
arrangements:
(1)
The individual’s own home, apartment, or room;
(2) The
home or apartment of a spouse, partner, relative, or friend where the
individual also resides;
(3) A
motel or hotel; or
(4) A
homeless shelter.
(r)
“Individual” means the adult requesting or receiving the Title III
social services described in He-E 502.05 and He-E 502.06.
(s)
“Informal resolution” means the process described in He-E 502.10 that is
conducted when an individual, or his or her authorized representative,
disagrees with an eligibility or termination determination.
(t) “Licensed practitioner” means a medical
doctor, physician’s assistant, advanced practice registered nurse, doctor of
osteopathy, doctor of naturopathic medicine, or anyone else with diagnostic and
prescriptive powers who is licensed by the appropriate New Hampshire licensing
board.
(u)
“Limited English proficiency” means the inability of an individual to
speak English as their primary language, and whose skills in listening,
speaking, or reading English are such that the individual cannot adequately
understand and participate in their care, or in the services provided to them,
without language assistance, the provision of communication access services, or
communication devices.
(v) “Nursing
facility” means a licensed nursing facility as defined in RSA 151-E:2, V.
(w) “Older
individual” means “older individual” as defined in 42 USC 3002(40), namely “an
individual who is 60 years of age or older.” The term includes “elderly” as
defined in RSA 161-F:1, V.
(x) “Person-centered” means that the individual
or his or her authorized representative or caregiver is the center of the
system of care, and the individuals’ needs and preferences drive the care and
services provided.
(y)
“Protective services” means “protective services” as defined in RSA
161-F:43, I, namely, “services and action which will, through voluntary
agreement or through appropriate court action, prevent neglect, abuse or
exploitation of incapacitated adults.
Such services shall include, but not be limited to, supervision,
guidance, counseling and, when necessary, assistance in securing of
nonhazardous living accommodations, and mental and physical examinations.”
(z)
“ServiceLink Resource Center” means a network of community-based sites
with the common purpose of providing information, referrals, and assistance to
connect older adults, adults living with disabilities, and their families and
caregivers with resources in their communities.
(aa)
“Walk-in service” means a session during which a Title III service
provider presents educational or informational material to an individual who
“drops-in” or “walks-in” to a location, event, or meeting.
(ab)
“Wait list” means a list of individuals who have been determined
eligible, and are ready to receive, a Title III service from a contract agency,
but for whom the agency does not have sufficient service units or resources to
serve the individuals.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.03
Confidentiality. All
information on individuals receiving Title III services and programs
administered by BEAS or a contract agency shall be kept confidential, and only
persons involved in administering Title III services and programs shall review
an individual’s information, unless the individual signs an authorization to
release the information to another person or organization.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.04
Title III Services.
(a)
Contract agencies shall determine eligibility and provide services for
all Title III services, except adult in-home care for which eligibility shall
be determined by
(b)
Contract agencies shall provide one or more of the following Title III
services:
(1)
Adult day program services;
(2)
Adult in-home care services;
(3)
Alcohol and substance abuse prevention services;
(4)
Dental services;
(5)
Elder abuse counseling;
(6)
Home health aide services;
(7)
Homemaker services;
(8)
Legal services;
(9)
Low vision service;
(10)
Nursing services;
(11)
Nutrition services: congregate meals;
(12)
Nutrition services: home delivered meals;
(13)
Prevention services; and
(14)
Transportation services.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.05
Eligibility Requirements for Services.
(a) To be eligible to receive Title III services,
an individual shall:
(1) Be 60 years of age or older, except as
specified in He-E 502.28(e)(1)-(4) Nutrition Services: Congregate Meals and
He-E 502.29(d)(1)-(4) Nutrition Services: Home Delivered Meals;
(2) Meet
any other requirements for the specific service or services being requested, as
described in He-E 502.18 through He-E 502.31;
(3) Reside
in an independent living situation, or be expected to transition to an
independent living situation prior to the initiation of services, with the
exception of legal services; and
(4) Not already be receiving the same or
duplicate services from another program such as a Medicaid waiver program.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.06
Service Requests and Process.
(a) An
individual or his or her authorized representative may request a Title III
service(s) from any contract agency that provides the service(s) being
requested, except that adult in-home care shall be requested from BEAS.
(b)
Individuals or their authorized representatives requesting Title III
services shall be required to self-declare their age.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.07
Determination, Notice of Eligibility, and Eligibility Period.
(a) An
individual shall meet the requirements in He-E 502.05 and 502.06 in order to be
deemed eligible to receive Title III services.
(b)
For individuals determined eligible to receive Title III services, the
eligibility period shall be for one year beginning on the date that eligibility
is determined and ending 364 calendar days later.
(c)
For individuals determined to be eligible to receive Title III services,
a written notice of the eligibility decision shall be provided by the contract
agency to the individual no later than 45 calendar days from the date of
determination for the following services:
(1) Adult day program services;
(2) Adult in-home care services;
(3) Home health aide services;
(4) Homemaker services;
(5) Nursing services; and
(6) Nutrition services: home delivered meals.
(d) If
the eligibility requirements are met, and services are available, the notice
shall include:
(1) The services to be provided, and when;
(2)
The eligibility period; and
(3) Contact information for the contract agency.
(e) If
the eligibility requirements are not met, the notice shall include:
(1) The reason(s) for the denial;
(2) A statement regarding the right of the
individual or his or her authorized representative to request an informal
resolution or appeal of the eligibility determination decision as described in
He-E 502.10; and
(3) Contact information for the contract agency.
(f) If
eligibility requirements for Title III services are met but services are not
available, the individual shall be notified that his or her name shall be
placed on a wait list in accordance with He-E 502.13.
(g)
For individuals expected to transition to and reside in an independent
living situation, Title III services shall not be provided until the individual
physically relocates to an independent living situation.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.08 Redetermination of Service Eligibility.
(a)
For those individuals determined to be eligible for Title III services,
the contract agency shall review the individual’s service record annually, as
long as service(s) is being provided.
The review shall be completed within 30 calendar days prior to the
anniversary date on which eligibility began.
(b)
The contract agency shall make a decision to continue or terminate the
individual’s Title III services based on the requirements contained in these rules
and document the decision by making a notation in the individual’s service
record.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.09
Termination or Significant Alteration of Services.
(a)
“Significant alteration” means a closure, location change, or other
change that restricts access to services.
(b) Title III services shall be terminated when:
(1) The individual no longer meets the
eligibility requirements for Title III services as described in He-E 502.05;
(2) Funding for the service(s) is no longer
available;
(3) The individual no longer requires the
service(s);
(4) The individual or his or her authorized
representative requests that the service(s) be terminated;
(5) The individual relocates to a geographical area outside the service delivery area or to an institutional setting;
(6) The contract agency’s contract to provide services is terminated; or
(7)
The individual expires.
(c) The
individual or his or her authorized representative shall be notified in writing
by the contract agency when the following services are terminated pursuant to
(a)(1)-(6) above:
(1) Adult day program services;
(2) Adult in-home care services;
(3) Home health aide services;
(4) Homemaker services;
(5) Nursing services; and
(6) Nutrition services: home delivered meals.
(d)
The notice of termination shall specify:
(1)
The service(s) to be terminated;
(2) The reason(s) for terminating the service(s);
(3)
The date upon which the service(s) shall be terminated which shall be 30
calendar days from the date of the notice, unless a request for an informal
resolution or appeal has been filed as described in He-E 502.10; and
(4)
The contact information for the contract agency staff member who
completed the notice.
(e) The
contract agency shall keep a copy of the termination in the individual’s
service record.
(f)
The contract agency shall make a notation in the individual’s service
record when the individual or his or her authorized representative elects to
terminate services.
(g) The contract agency shall send written notice
to BEAS when services are terminated for individuals receiving the following
Title III service authorized services:
(1) Adult day program services;
(2) Adult in-home care services;
(3) Home health aide services;
(4) Homemaker services;
(5) Nutrition services: congregate meals, and
(6) Nutrition services: home delivered meals.
(h)
The contract agency shall keep a copy of the notice sent in (f) above in
the individual’s service record.
(i) If
a contract agency wishes to terminate services to an eligible individual who is
currently receiving services because the contract agency determines that the
individual’s behavior or living environment creates a health or safety hazard for
contract agency staff, then:
(1)
The contract agency shall:
a.
Consult with
b. Following consultation with BEAS, document
and report to
c. Send BEAS written notification of a final
decision to terminate including a summary of the efforts the contract agency
has made to resolve the situation prior to sending the termination notice to
the individual; and
d. Document in the individual’s service record a
description of the individual’s behavior(s) or living environment that created
a health or safety hazard for contract agency staff, as well as the contract
agency’s attempts to continue to provide services; and
(2) The contract agency shall send written notice
to an individual within 5 business days of notifying
(3)
When an individual’s behavior or living environment presented a
perceived imminent danger to contract agency staff or a contract agency
volunteer, the contract agency may choose to temporarily suspend service until
the requirements in (i)(1) above can be met.
(j)
The individual or the individual’s authorized representative shall be
notified when the following services are significantly altered:
(1)
Adult day program services;
(2)
Adult in-home care services;
(3)
Home health aide services;
(4)
Homemaker services;
(5)
Nursing services; and
(6)
Nutrition services: home delivered meals.
(k)
The notice of significant alteration shall specify:
(1)
The service(s) to be significantly altered;
(2)
The reason(s) for the significant alteration;
(3)
The date upon which the service(s) shall be significantly altered; and
(4)
The contact information for the contract agency staff member who
completed the notice.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.10
Informal Resolution.
(a) An
individual who disagrees with an eligibility or termination determination as
described in He-E 502.07 or He-E 502.09 may request an informal resolution of
the decision, as follows:
(1)
The individual, or his or
her authorized representative, shall submit a written request to the BEAS
bureau director, or designee, within 30 calendar days of the eligibility or
termination determination; and
(2) The written request shall include an
explanation of the reason why the eligibility or termination determination
should be changed, including any supporting documentation.
(b) For individuals currently receiving services, Title III services shall continue during
the informal resolution process until a decision is rendered.
(c) The
BEAS bureau director, or designee, shall review the request in (a) above and
provide a written notice to the individual, or his or her authorized
representative, of the decision to maintain or change the original eligibility
or termination decision, including the reason therefor.
(d) If
the contract agency’s or
(1) Services shall be initiated for individuals
requesting services; and
(2) Services for individuals currently receiving
Title III services shall continue as long as the Title III eligibility
requirements described in He-E 502.05 are met or until the end of the
individual’s eligibility period.
(e) If
the contract agency or
(f) Requesting
an informal resolution shall not:
(1)
Preclude in any way an individual’s right to appeal a disputed
eligibility or termination determination in accordance with He-C 200; or
(2)
Change the timeframes established for filing an appeal.
(g) An individual
may appeal the decision of the bureau director or designee in (c) above, in
accordance with He-C 200.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E
502.11 Contract Agency
Requirements.
(a)
Agencies wishing to provide Title III services shall be under contract
with
(b)
Contract agencies shall:
(1)
Comply with all provisions included in the contract with
(2)
Determine eligibility for individuals requesting service and comply with
notification and other documentation requirements as described in these rules;
(3)
Target outreach and direct services toward one or more of the goals
contained in 45 CFR 1321 and 42 U.S.C. 3001 with emphasis placed on
serving the groups of individuals described in He-E 502.01(b)(1)-(7);
(4) Develop person-centered plans as
described in He-E 502.17 that encourage the full participation of the
individual or his or her authorized representative(s) in the service planning
and decision making process;
(5)
Coordinate and monitor the provision of services as described in the
person-centered plan to ensure there is no duplication of Title III or other
services being provided to the individual;
(6) Comply with and make available to BEAS upon
request any licensing or certification requirements required by applicable
federal, state, or local laws or rules;
(7)
Maintain the insurance coverage required
by applicable state or local laws or rules, and provide written proof of such
insurance coverage to BEAS;
(8) Identify an executive director or designee
who will oversee the services provided by the contract agency;
(9) Identify
staff who will complete the
responsibilities contained in this rule for the service(s) being provided;
(10)
Train and supervise contract agency staff and volunteers on the
following:
a. The contract agency’s policies and
procedures;
b. The specific Title III services the staff or
volunteer will be providing; and
c. Any additional training requirements
contained in applicable federal or state laws or rules;
(11) Comply with all contract requirements
regarding the provision of communication access to individuals who are requesting or receiving services covered
under this rule;
(12) Develop
procedures for staff responses to emergencies;
(13) Unless
otherwise prohibited by law, develop procedures for reporting suspected abuse,
neglect, self-neglect, or exploitation of incapacitated adults as required by
RSA 161-F:46 of the adult protection law;
(14) Comply
with the provisions of RSA 161-F:49 with regard to checking the names of
prospective or current employees, volunteers, or subcontractors against
the
(15) Have
an established written complaint and incident process that may be accessed by
individuals, family members, or authorized representatives when an individual
is denied services or dissatisfied with the services provided by the contract
agency, including:
a. The name or position of the contract agency
staff member who coordinates the complaint and incident process;
b. The issues that may be addressed through the
complaint and incident process;
c. How individuals are informed of their right
to file a complaint or incident report;
d. The procedures to be followed by individuals
who wish to file a complaint or incident report with the contract agency;
e. The procedures to be followed by the contract
agency when reviewing complaints or incidents, and for notifying the individual
of the outcome of the review; and
f. Information stating that the availability of
the complaint and incident process from the contract agency shall not cancel
the right of an individual who is denied Title III services to request an
informal resolution or appeal in
accordance with He-E 502.10 and He-C 200;
(16) Provide information to BEAS when requested
regarding individuals receiving services, except for services provided under He-E 502.25 Legal Services;
(17) Comply with all
(18) Comply
with all
(19) Maintain service records in accordance with
He-E 502.15 for the specific Title III service(s) being provided;
(20) Submit
fiscal reports to
(21) Submit information on the wait list in
accordance with He-E 502.13;
(22) Engage in monitoring and evaluating the
quality of the services being provided, which shall include:
a. Obtaining feedback from the individual or his
or her authorized representative or from family members as applicable;
b. Participating in any quality assurance
measures implemented by
c. Making changes as necessary to improve the
quality and effectiveness of service delivery; and
(23) When
providing nutrition services: home-delivered meals:
a.
Be in compliance with federal, state,
and local regulations for food safety, meal preparation, and delivery;
b.
Employ staff or subcontract with another entity to prepare and deliver meals in
accordance with the regulations in a. above;
c.
Demonstrate on a quarterly basis that meals are in compliance with the dietary
requirements contained in He-E 502.29 by providing BEAS with menus which are
signed by a registered dietitian or another professional with comparable
expertise;
d. Ensure that
contract agency staff:
1. Has
direct contemporaneous contact with each individual; and
2. Reports any observations of unusual
circumstances to the designated contract agency supervisor or, in the case of
an emergency, calls emergency personnel; and
e.
Keep a record of the number of meals authorized for the individual, the
scheduled days of delivery, and the number of meals served.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by
#13354, eff 3-19-22
He-E 502.12 Voluntary Donations.
(a)
The contract agency shall not charge fees or bill individuals receiving
Title III services.
(b) In
accordance with Title III, the contract agency shall provide each individual
with an opportunity to voluntarily donate to the cost of the service, as
follows:
(1)
The contract agency shall clearly inform each individual that there is
no obligation to donate, that a donation is purely voluntary, and that the
individual shall not be denied services because he or she does not donate; and
(2)
The contract agency may suggest an amount for a donation, but shall not
use means testing as the basis for the donation or expect the donation to cover
the full cost of services.
(c)
The contract agency shall also:
(1) Protect the
privacy and confidentiality of each individual with respect to the individual’s
donation or lack of a donation;
(2) Establish appropriate procedures to safeguard and account for all donations; and
(3) Use all donations to support the program for which donations were given.
(d)
For individuals with an open APS protective services case as
described in He-E 700, the APS program rule, the contract agency shall not
attempt to secure additional reimbursement, including donations, of any type
from the individual or his or her family members or authorized representative
for those services.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.13
Wait Lists.
(a)
All services covered by He-E 502 shall be provided to the extent that funds,
staff, and resources for this purpose are available.
(b)
The contract agency shall maintain a wait list for Title III services
when funding or resources are not available to provide the services, except
that a wait list for Title III group educational or walk-in services shall not
be required.
(c)
The wait list shall be maintained for individuals:
(1)
Who are newly eligible and ready to receive services;
(2)
Who are already receiving services and are requesting additional
services; and
(3) Who relocate outside of the catchment area for
the contract agency providing services and are requesting Title III services
from a contract agency in the new location.
(d)
Each contract agency shall include the following information on its wait
list:
(1)
The individual’s full name and date of birth;
(2)
The name of the Title III service being requested;
(3)
The target date, if known, of implementing the services based on the
communication between the individual and the contract agency;
(4)
The date upon which the individual’s name was placed on the wait list,
which shall be the date of the notice of decision in which the individual was
determined eligible for Title III services;
(5)
The individual’s assigned priority on the wait list, determined in accordance
with (e) below; and
(6) If
the individual is already receiving a Title III service, the type and amount of
the services received.
(e)
The contract agency shall prioritize each individual’s standing on the
wait list by determining the individual’s urgency of need in the following
order:
(1)
Individual has an open APS protective services case;
(2)
Individual is not already receiving services through one of DHHS’
Medicaid waiver programs, or who may be eligible for other NH Medicaid services;
(3)
Individual is identified by Title III as belonging to one of the
following groups, as described in He-E 502.01(b)(1)-(6):
a.
Individuals with severe disabilities;
b. Low
income minority older individuals;
c.
Native Americans;
d. Older
individuals in greatest social or economic need;
e. Older
individuals residing in rural areas; and
f. Older
individuals with limited English proficiency;
(4)
Individual is at risk of being admitted to an institutional setting due
to:
a.
Declining mental or physical health of the caregiver;
b.
Declining mental or physical health of the individual; or
c.
Individual living with a caregiver who is in need of substitute or
respite care due to the temporary incapacity, illness, or unavailability of the
regular caregiver;
(5)
Length of time on the wait list; and
(6)
Individual is transitioning from an institutional setting.
(f)
When 2 or more individuals on the wait list have been assigned the same
service priority, the individual served first will be the one with the earliest
eligibility determination date.
(g)
The individual may reserve the right to remove his or her name from the
wait list at any time or apply for Title III services with another contract
agency.
(h)
When an individual is placed on the wait list, the contract agency shall
notify the individual in writing and include the following information:
(1) A
statement that Title III services are not covered because funds, staff, or
resources are unavailable;
(2) A
brief description of the contract agency’s wait list process;
(3)
The estimated period of time that the contract agency expects the
individual to remain on the wait list;
(4) A
statement that notifies the individual of the right to remove his or her name
from the wait list and to request Title III services with another contract
agency;
(5) A
statement that directs the individual to the specified NH ServiceLink toll-free
telephone number for more information on other contract agencies in the
individual’s catchment area that provide the Title III service being requested;
(6)
The contact information for the contract agency(ies); and
(7) A
statement requesting that the individual notify the contract agency if his or her
service needs change or if the individual begins to receive the requested Title
III service from another contract agency.
(i)
Upon becoming aware of availability to provide a Title III service, the
contract agency shall immediately call and send written notice to the
individual requesting Title III services based on the priority outline in (e)
above and, if appropriate, the assigned APS protective social worker.
(j)
The individual shall respond to the contract agency within 10 business
days of the date on the written notice, indicating whether or not they still
wish to receive the Title III services.
(k) If
the individual does not respond within 10 business days, the contract agency
shall no longer be obligated to provide Title III services to that individual.
(l)
The individual may make another request for Title III services in
accordance with He-E 502.06 and 502.07.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.14
Service Authorization.
(a)
Once the individual has been determined eligible to receive Title III
services, the following Title III services shall be authorized by the contract
agency, acting on behalf of
(1)
Adult day program services;
(2)
Adult in-home care services;
(3)
Home health aide services;
(4)
Homemaker services;
(5)
Nutrition services: congregate meals; and
(6)
Nutrition services: home delivered meals.
(b) Service
authorizations shall consist of the specific types of services required
to meet the needs identified on the individual’s person-centered plan.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.15
Service Records.
(a)
Contract agencies shall maintain a service record for all individuals
receiving one or more Title III services except as provided in (h) below.
(b)
The service record shall contain:
(1)
The individual’s name, address, and telephone number;
(2) A
notation that the individual meets the eligibility requirements for services as
described in He-E 502.05;
(3) An
annual notation of the decision to recertify or terminate services as described
in He-E 502.08;
(4)
Notation of the following:
a. The name of the Title III service(s) being provided and the type of service activities, based on the service description contained in this rule;
b. The dates of service provision and the number of service units provided;
c. Identification of the individual’s communication access needs, including type and modality, and the name of the communication access provider or type of device utilized, if applicable; and
d. Any other information or correspondence deemed relevant to service provision; and
(5)
The service authorization as described in He-E 502.14(a), if applicable.
(c)
The following services shall require additional documentation in the
service record:
(1)
Adult in-home care services;
(2)
Home health aide services;
(3)
Homemaker services;
(4)
Nursing services; and
(5)
Nutrition services: home delivered meals.
(d)
The additional documentation specified in (c) above shall include:
(1) A
copy of the notice of decision for the provision of service(s) as described in
He-E 502.07, as applicable;
(2)
The name and telephone number of a person who may be contacted in an
emergency;
(3) The name, address, and telephone number
of the individual’s primary caregiver, if applicable;
(4)
The name and telephone number of the individual’s licensed practitioner,
if applicable;
(5)
Documentation of changes in the individual’s health or other
circumstances affecting service provision;
(6) A
copy of any termination notification(s) to the individual and
(7)
The person-centered plan as described in He-E 502.17;
(8)
The dates upon which service(s) will begin and end;
(9)
The planned frequency of the service(s);
(10)
The total number of service units that will be provided on each date of
service, if appropriate; and
(11)
Copies of all executed legal directives provided to the contract agency,
such as guardianship orders for health care under RSA 464-A, a durable power of
attorney or a living will, or any advanced directives under RSA 137-J.
(e)
Contract agencies providing adult day program services shall be required
to comply with all documentation requirements as described in He-P 818, in
addition to the requirements outlined in He-E 502.15(b).
(f)
Service records shall be kept confidential in accordance with He-E
502.03 and all applicable federal and state laws and regulations.
(g)
Service records shall be retained for a period of 4 years after services
have ended or have been terminated.
(h) No
service record shall be required for individuals receiving only group
educational or walk-in services, or telephone services as described in He-E
502.25 Legal Services.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.16
Cessation of Title III Services by a Contract Agency.
(a)
When a contract agency decides to terminate its contract for a Title III
service, the agency shall provide written notification to BEAS in accordance
with the terms of the contract.
(b) The contract
agency shall develop and submit a transition plan for services under the
agreement, including, but not limited to, identifying the present and future
needs of individuals receiving services under the agreement and establishing a
process to meet those needs in accordance with the terms of the contract.
(c)
The contract agency shall also comply with any other provisions
contained in its contract with respect to the cessation of Title III services.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.17 Person-Centered Plan.
(a)
Contract agencies providing the Title III services described in this
rule shall develop a person-centered plan for individuals receiving one or more
of the following services:
(1)
Adult day program services;
(2)
Adult in-home care services;
(3)
Home health aide services;
(4)
Homemaker services;
(5)
Nursing services; and
(6)
Nutrition services: home-delivered meals.
(b)
The person-centered plan shall be based on the individual’s needs and
developed with input from the individual or his or her authorized
representative so that services are designed, scheduled, and delivered to best
meet the needs and preferences of the individual, and the individual is
supported as a full participant in the service planning and decision-making process.
(c)
The person-centered plan shall include:
(1) Identification
of the anticipated needs, goals, and outcomes of service provision from the
perspective of the individual;
(2)
Documentation that the person-centered plan was developed with input from
the individual or his or her authorized representative;
(3) Documentation, as appropriate, to reflect the
person-centered plan is responsive to the changing needs of the individual; and
(4)
Information on the individual’s health condition, medications,
allergies, and special dietary needs as appropriate to the service being
provided in order to assess the individual’s service needs and to coordinate
service.
(d)
The contract agency shall provide service to individuals based on the
person-centered plan.
(e)
The person-centered plan shall be updated annually or whenever there is
a change in the individual’s living arrangement or health status, or a change
requested by the individual and agreed to by the parties.
(f) In
addition to the requirements in (c) above, contract agencies providing adult
day program services shall be required to comply with all care plan
requirements described in He-P 818.
(g) In
addition to the requirements in (c) above, for individuals receiving
home-delivered meals, the person-centered plan shall include:
(1)
The number of meals to be delivered and when the meals are to be
delivered;
(2)
Documentation of any other special needs or factors that could impact
service provision; and
(3)
Consideration of the individual’s nutritional needs, including to the
extent possible, any special dietary needs and preferences.
Source.
(See Revision Note
at part heading for He-E 502) #10530,
eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.18 Adult Day Program Services.
(a)
Contract agencies providing adult day program services shall:
(1) Be
licensed and comply with all duties and responsibilities of licensees as
required in He-P 818;
(2)
Provide the required services described in He-P 818; and
(3) Maintain
records as described in He-P 818.
(b) In
order for an individual to be eligible to receive Title III adult day program
services, the individual’s licensed practitioner shall:
(1)
Complete a physical examination on the individual within 60 calendar
days prior to the request for services; and
(2)
Refer the individual for adult day program services, because the individual:
a. Has been diagnosed as having an illness or disability; and
b. Requires adult day program services.
(c) Adult
day program services shall not be available to anyone:
(1)
Who resides in a nursing facility or other licensed or certified facility;
(2)
Who receives adult family care services pursuant to He-E 801.14;
(3)
Whose needs cannot be met by the adult day program; or
(4)
Who is primarily seeking services to support needs related to a
diagnosis of mental illness or developmental disability.
Source.
(See Revision Note
at part heading for He-E 502) #10530,
eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.19
Adult In-Home Care Services.
(a) To
be eligible for adult in-home care services, the individual shall have an open
APS protective services case and be assessed to be in need of adult in-home
care services by an adult protective services social worker.
(b) Adult
in-home care services shall be provided by employees of:
(1)
Home health care providers licensed in accordance with RSA 151:2 and
He-P 809;
(2)
Home care service providers licensed in accordance with RSA 151:2 and
He-P 822; or
(3)
Other qualified agencies certified in accordance with RSA 161-I and He-P
601.
(c)
Contract agencies providing adult in-home care services shall provide
the following core household maintenance tasks based on the individual’s needs
including:
(1)
Housecleaning;
(2)
Laundry;
(3)
Maintaining a safe environment in areas of the home used by the
individual;
(4)
Meal preparation for the individual only and not for other members of
the household;
(5)
Rearranging light-weight furniture to assure the individual can safely
ambulate to reach food, water, medication, and other essential items;
(6)
Shopping for groceries and other errands for the individual receiving
services only; and
(7)
Instructing the individual to perform core household maintenance tasks
necessary to maintain the individual’s well-being, safety, and independence.
(d) Contract
agencies providing adult in-home care services shall facilitate one or more of
the following activities of daily living or instruction in self-care, based on
the individual’s needs including:
(1)
Bathing;
(2)
Dressing;
(3)
Eating and drinking;
(4)
Grooming;
(5)
Taking medication as allowed in He-P 809 and He-P 822; and
(6) Toileting.
(e) Contract
agencies providing adult in-home care services shall:
(1)
Provide and encourage socialization; and
(2)
Evaluate the individual’s progress and when necessary, provide
information about, and referral to, other resources.
(f) Contract
agencies shall coordinate adult in-home care services to ensure that there is
no meal preparation being provided when home delivered meals will be delivered
to the individual, and that there is no duplication of additional Title III or
other services being provided to the individual.
(g) At
least every 3 months the contract agency shall meet with a
(1)
The status of each individual receiving adult in-home care services; and
(2) Whether any changes are needed regarding
the type or frequency of service being provided.
(h) If
the individual continues to have an open APS protective services case beyond 6
months, the adult protective services social worker shall confer with the
appropriate
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
He-E 502.20 Alcohol and Substance Abuse Prevention
Services.
(a) A contract
agency shall administer alcohol and substance abuse prevention services, as
follows:
(1)
Within the contract agency, a prevention specialist certified by the
Prevention Certification Board of New Hampshire shall oversee the provision of
alcohol and substance abuse prevention services; and
(2)
The prevention specialist’s certification shall be kept current in
accordance with the requirements of the Prevention Certification Board of New
Hampshire.
(b) Alcohol
and substance abuse prevention services shall include:
(1) Brief intervention and counseling provided by
counselors from
a.
There shall be subcontracts for this purpose between the mental health
centers and the contract agency administering alcohol and substance abuse
prevention services;
b. Oversight and training of counselors shall
be provided by the contract agency administering alcohol and substance abuse
prevention services; and
c. A
maximum of 5 counseling sessions per individual shall be provided, and for each
individual:
1. Screening shall be completed and
documented by the counselor using age-appropriate evidence-based screening
tools identified by the contract agency administering alcohol and substance
abuse prevention services;
2.
Goals shall be identified and strategies for accomplishing these
goals shall be developed, including referrals to other resources as needed; and
3. A
record shall be kept by the counselor of all visits with the individual;
(2)
Group educational programs, which shall be held in community-based
locations, and address topics such as:
a. Preventing or alleviating the misuse of
alcohol, medications, or other drugs;
b.
Life changes;
c. Depression or emotional stress;
d.
Grief and loss;
e. Opportunities to reduce isolation, improve social
interaction, and improve interpersonal relationships; and
f.
Other issues that enhance an individual’s ability to live independently,
such as home safety and injury
prevention; and
(3)
Outreach services to encourage individuals to participate in group
educational programs.
(c) Contract
agencies providing alcohol and substance abuse prevention services shall:
(1) Provide resource materials that are
specific to preventing or alleviating substance misuse among older individuals,
and, at the option of the contract agency, resource materials on the other issues
identified in (b)(2) above; and
(2) Provide handouts for individuals related
to the group educational sessions described in (b)(2) above.
(d)
The contract agency administering alcohol and substance abuse prevention
services shall keep a log of each group educational activity that includes:
(1)
The date of the group educational activity;
(2)
The topic of the group educational activity; and
(3)
The names of attendees.
(e) The
contract agency administering alcohol and substance abuse prevention services
shall conduct evaluations on the effectiveness of these services and provide
the results of these evaluations annually to
(f)
The contract agency administering alcohol and substance abuse prevention
services shall complete quarterly program reports.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22
(formerly
He-E 502.21)
(a) Dental services shall include:
(1) Oral exams, including cancer screenings,
which are performed to detect and prevent dental diseases and to identify an
individual’s dental care needs;
(2) Cleanings;
(3) Restorations;
(4) Prostheses, such as dentures and partial
dentures;
(5) Surgical procedures to address infections;
(6) Education regarding dental health; and
(7) When necessary, referrals to other dental or
medical services.
(b) Dental services shall be provided by contract
agencies or vendors that:
(1) Meet the requirements contained in He-E
502.11 and in any other applicable state laws or rules; and
(2) Employ staff members who are licensed by the
NH board of dental examiners in accordance with RSA 317-A.
(c) Contract agencies providing dental services
may utilize students enrolled in accredited dental hygiene and dental care
programs to assist in the provision of dental care services provided that these
students are supervised by contract agency staff that is licensed in accordance
with applicable state laws or rules.
(d) For each individual receiving dental
services:
(1) An assessment shall be completed and
documented;
(2) Goals shall be identified and an individual
treatment plan developed; and
(3) Progress notes shall be made by the staff
member after each dental visit.
(e) Dental work done only for aesthetic purposes
shall not be covered.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.22)
He-E 502.22
Elder Abuse Counseling.
(a)
Elder abuse counseling services shall meet the needs of individuals who
require assistance in resolving problems or relieving temporary stresses. Problems addressed may include elder abuse,
neglect, self-neglect, exploitation, or physical harm inflicted.
(b) Contract
agencies conducting elder abuse counseling shall provide the following
services:
(1)
Assisting and supporting individuals in resolving problems and relieving
stress;
(2)
Providing one-on-one or group educational sessions; and
(3)
Group educational service programs for individuals on topics concerning
the prevention of elder abuse, neglect or self-neglect, and exploitation.
(c)
Elder abuse counselors shall be licensed as social workers or mental
health practitioners by the State of New Hampshire in accordance with RSA 330-A,
and have a working knowledge of effective geriatric assessment tools, mental
health issues affecting older individuals, and elder abuse treatment
resources.
(d)
For each individual receiving elder abuse counseling:
(1) An
assessment shall be completed and documented;
(2)
Goals shall be identified and an individual treatment plan developed;
and
(3)
Progress notes shall be made by the counselor following each counseling
session.
(e)
Contract agencies providing elder abuse counseling services shall keep a
service provision log of all group educational activities that includes:
(1)
The date of the group educational activity provided;
(2)
The type of the group educational activity provided;
(3)
The names of the attendees; and
(4)
Comment on any follow-up action as needed.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.23)
He-E 502.23
Home Health Aide Services.
(a) Home health aide services shall be provided by
a home health care provider licensed in accordance with RSA 151:2 and He-P 809.
(b)
Home health aide services shall be covered when provided by a licensed
nursing assistant (LNA) working within the LNA scope of practice, pursuant to
Nur 700.
(c)
The following home health aide services shall be covered based on the
individual’s need:
(1)
Services allowed within the LNA scope of practice, pursuant to Nur 700;
and
(2)
Personal care services, as described in He-E 801.22(b), when the individual’s
person-centered plan contains documentation that his or her functional or
medical condition necessitates the performance of such tasks by an LNA and not
an unlicensed provider.
(d) Contract
agencies shall coordinate home health aide services to ensure that there is no
duplicate provision of services when the individual is also receiving home
delivered meals, other Title III services, or services at an adult medical day
program, in an assisted living facility, or in an adult family care home.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.24)
He-E 502.24
Homemaker Services.
(a) Homemaker services shall be provided by employees
of:
(1)
Home health care providers licensed in accordance with RSA 151:2 and
He-P 809;
(2)
Home care service providers licensed in accordance with RSA 151:2 and
He-P 822; or
(3)
Other qualified agencies certified in accordance with RSA 161-I and He-P
601.
(b)
Contract agencies providing homemaker services shall provide the
following core household maintenance tasks based on the individual’s needs,
including:
(1)
Housecleaning;
(2)
Laundry;
(3)
Maintaining a safe environment in areas of the home used by the
individual;
(4)
Preparation of non-communal meals;
(5)
Rearranging light-weight furniture to assure the individual can safely
ambulate to reach food, water, medication, and other essential items;
(6)
Shopping for groceries and other errands; and
(7)
Instructing the individual to perform core household maintenance tasks
necessary to maintain the individual’s well-being, safety, and independence.
(c) Contract
agencies providing homemaker services shall facilitate one or more of the
following activities of daily living or instruction in self-care, based on the
individual’s needs including:
(1) Bathing;
(2)
Dressing;
(3)
Eating and drinking;
(4)
Grooming;
(5)
Taking medication as allowed in He-P 809 and He-P 822; and
(6)
Toileting.
(d) Contract
agencies providing homemaker services shall:
(1)
Provide and encourage socialization; and
(2)
Evaluate the individual’s progress and when necessary, provide
information about, and referral to, other resources.
(e) Contract
agencies shall coordinate homemaker services to ensure that there is no meal
preparation being provided when home delivered meals will be delivered to the
individual, and that there is no duplication of additional Title III or other
services being provided to the individual.
Source.
(See Revision Note
at part heading for He-E 502) #10530,
eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.25)
He-E 502.25
Legal Services.
(a) Legal
services shall be provided to individuals who are in need of assistance from a
paralegal or attorney as described in Title III, and include:
(1)
The provision of statewide telephone access through a toll-free number;
(2)
Performing community outreach and education, including the provision of
written materials to increase awareness of legal rights and legal services; and
(3)
The provision of legal advice, counseling, and litigation services by
attorneys, or legal assistants working under the supervision of an attorney, in
accordance with the administrative rules of the Supreme Court of the State of
NH to address civil matters including, but not limited to:
a. Consumer issues relating to debt collection,
financial exploitation, and health care services;
b. Family matters;
c. Matters involving public assistance benefits;
d. Matters involving utility shut-off;
e. Nursing facility and assisted living facility
issues;
f. Public and private housing matters;
g. The
provision of legal representation at hearings or in court; or
h. The
provision of referral services to other sources of local assistance.
(b)
For each individual receiving counseling and litigation legal services, a
case record shall be developed and maintained and case notes be kept as
required by He-E 502.15 following each counseling or litigation session.
(c)
Contract agencies providing legal services shall keep a service
provision log of all telephone, walk-in, and group educational activities which
includes:
(1)
The date of the telephone call, walk-in, or group educational activity;
(2)
The type of interaction provided;
(3)
The name of the individual(s) counseled; and
(4)
Comment on any follow-up service provided.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.26)
He-E 502.26
Low Vision Services.
(a) Low
vision services shall be provided to individuals who are blind or visually
impaired in order to help them perform activities of daily living and attain an
optimal level of independence and quality of life.
(b) Contract
agencies providing low vision services shall include the following activities,
based on the individual’s needs:
(1)
Vision rehabilitation, including the evaluation, diagnosis, and
management of visual impairment;
(2)
Mobility, optical aid, and orientation training;
(3) Counseling
on adjustment to vision loss, including referrals to support groups and other
appropriate community services; and
(4)
The prescription of optical, non-optical, electronic devices, or other
treatments.
(c)
Low vision services shall be provided by a licensed practitioner
appropriate to the service being delivered.
(d)
For each individual receiving low vision services:
(1) An
assessment shall be completed and documented;
(2)
Goals shall be identified and an individual treatment plan developed;
and
(3) Progress
notes shall be made by the licensed practitioner following each visit session.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.27)
He-E 502.27
Nursing Services.
(a)
Nursing services shall be provided in an individual’s home by a home
health care provider licensed in accordance with RSA 151:2 and He-P 809.
(b) Nursing
services shall be covered when provided by a licensed practical nurse (LPN) or
registered nurse working within the scope of services allowed under the Nurse
Practice Act, RSA 326-B.
(c)
The following nursing services shall be covered based on the individual’s
need:
(1)
Receiving referrals;
(2) Evaluation
of the individual’s needs;
(3) Developing a nursing care plan and
incorporating this information into the individual’s person-centered plan; and
(4)
Providing nursing services in accordance with the individual’s
person-centered plan as described in He-E 502.17 and ordered by his or her
physician.
(d) Contract
agencies shall coordinate nursing services to ensure that there is no duplicate
provision of services.
(e)
LPN and registered nursing services shall not be covered when provided
for the purpose of nursing oversight of authorized LNA services.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.28)
He-E 502.28
Nutrition Services: Congregate Meals.
(a)
Contract agencies providing congregate meals shall:
(1)
Provide meals in a congregate setting that affords opportunity for social
contact; and
(2)
Comply with state and local regulations on the safe and sanitary
handling of food, equipment and supplies used in the storage, preparation,
service, and delivery of meals as described in He-P 2300.
(b) Congregate
meals shall include at least one hot or other appropriate meal per day for 5 or
more days per week except in rural areas
where such frequency is not feasible and a lesser frequency is approved by BEAS.
(c) Contract
agencies approved to provide services at a lesser frequency pursuant to (b)
above shall keep the approval on file. Approval of a contract with a lesser
frequency shall constitute approval pursuant to (b) above.
(d) Each
meal shall:
(1)
Include a minimum of 33 1/3 percent of the dietary reference intakes established
by the Food and Nutrition Board of the Institute of Medicine, National
Academies of Sciences, Engineering, and Medicine and comply with the U.S. Department of Agriculture and the U.S.
Department of Health and Human Services “Dietary Guidelines for Americans,
2020-2025” (Ninth Edition), available as noted in Appendix A; and
(2)
Accommodate, to the extent possible, the special dietary needs or
preference of the individual, including recommendations from the individual’s
licensed practitioner, or preferences stemming from the individual’s cultural
or religious background.
(e) In
addition to offering congregate meals to individuals who meet the eligibility
requirements contained in this rule, contract agencies providing this service
may also offer a meal, on the same basis as meals provided to eligible older
individuals, to:
(1)
The spouses of individuals who accompany them to the meal site;
(2)
Persons providing volunteer services as part of the meal service,
including caregivers during meal hours;
(3)
Persons with disabilities under the age of 60 who reside at home with an
individual who is receiving Title III services; and
(4)
Persons with disabilities under the age of 60 who reside in housing facilities occupied by older
individuals where congregate meals are provided.
(f) Contract
agencies providing nutrition services: congregate meals shall keep a service
provision log of all meals that includes:
(1)
The date of the meal;
(2)
The name of the person the meal was provided to; and
(3)
Comment on any follow-up service provided.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.29)
He-E 502.29
Nutrition Services: Home-Delivered Meals.
(a) Home-delivered
meals shall be provided to individuals who:
(1)
Meet the eligibility requirements contained in He-E 502.05; and
(2) Meet
one or more of the following requirements:
a. Have
limited capacity to prepare meals without assistance;
b.
Have limited ability to leave their residence; or
c. Are
unable to consume meals at a congregate dining location due to physical,
emotional, or mental difficulties or limited desire for social interactions.
(b) Contract
agencies providing home-delivered meals shall:
(1)
Comply with state and local regulations on the safe and sanitary
handling of food, equipment and supplies used in the storage, preparation,
service, and delivery of meals as described in He-P 2300; and
(2)
Accommodate, to the extent possible, the special dietary needs and
preference of the individual, including recommendations from the individual’s
licensed practitioner, and preferences stemming from the individual’s cultural
or religious background.
(c)
Each meal shall include at least a minimum of 33 1/3 percent of the
dietary reference intakes established by the Food and Nutrition Board of the
Institute of Medicine, National Academy of Sciences, Engineering and Medicine
and comply with the U.S. Department of Agriculture and the U.S. Department of Health
and Human Services “Dietary Guidelines for Americans, 2020-2025” (Ninth
Edition), available as noted in Appendix B.
(d) In
addition to offering home-delivered meals to individuals who meet the
eligibility requirements contained in this rule, contract agencies providing
this service may also offer meals to:
(1)
The spouses of individuals;
(2)
Persons providing volunteer service through a volunteer service program
such as the Retired and Senior Volunteer Program (RSVP) or Senior Companion
Program who are working at the recipient’s home during meal hours or
volunteering during the service delivery process;
(3)
Persons with disabilities who are under the age of 60 who reside at home
with an individual who is receiving Title III services; and
(4) Persons
with disabilities under the age of 60 who reside in housing facilities occupied
primarily by older individuals at which congregate meals are provided.
(e) The
contract agency providing home-delivered meals shall at least 3 times per year
distribute to all individuals receiving home-delivered meals, educational
materials on nutrition and wellness, including, but not limited to, the
following:
(1)
Printed materials available at no cost from federal, state, or local
government sources or from other agencies; or
(2)
Information provided by the contract agency through another venue, such
as a newsletter.
(f) The contract agency shall provide individuals
referrals to other services or programs as necessary.
(g)
Contract agencies shall coordinate the provision of home delivered meals
to ensure that there is no duplication of services when additional Title III or
other services are being provided to the individual, and that the individual is
present to receive the meal. Meals that
are delivered to an individual’s home when the individual is not at home shall
not be reimbursed.
(h)
Contract agencies providing home-delivered meals shall keep a service
provision log of all meals delivered that includes:
(1)
The date of the meal;
(2)
The name of the person the meal was delivered to; and
(3)
Comment on any follow-up service provided or referrals to other
services.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14; ss by #13354, eff 3-19-22 (formerly
He-E 502.30)
He-E 502.30 Prevention Services.
(a)
Prevention services shall be covered for individuals who meet the
eligibility requirements for Title III services as described in He-E 502.05.
(b) Prevention
services shall include, but not be limited to:
(1)
Evidence-based health screenings that can detect the presence of, or an
individual’s risk for, heart disease, diabetes, cancer, asthma, strokes, vision
loss, hearing loss, or other chronic diseases or conditions;
(2)
Evidence-based group educational programs or individual counseling on
topics such as nutrition, exercise, mobility, medication management, pain
management, home safety, the emotional aspects of chronic disease or
conditions, or other related topics;
(3)
Individual assessments and the development of individual action plans to
help prevent injuries or prevent or manage chronic diseases or conditions; and
(4)
Referrals to other service providers as necessary, including health care
providers who can follow up on further prevention or treatment of chronic
diseases or conditions.
(c) For
each individual receiving prevention services that include individual
counseling, assessments, or action plans:
(1) An
assessment shall be completed and documented;
(2)
Goals shall be identified and an individual treatment plan developed;
and
(3)
Progress notes shall be made by the counselor following each contact or
session.
(d) Contract
agencies providing prevention services shall keep a service provision log for
health screenings, referrals, group educational services, or walk-in service
activities that includes:
(1)
The date of the activity;
(2)
The type of activity or service provided;
(3)
The name(s) of the attendee(s) or service recipient(s); and
(4)
Comment on any follow-up service provided.
Source.
(See Revision Note
at part heading for He-E 502) #10530,
eff 2-28-14 (formerly He-E 502.31)
He-E 502.31 Transportation.
(a) Transportation services shall be covered for
the purpose of accessing the following types of services:
(1)
Title III services, except home delivered meals;
(2)
Medical appointments;
(3)
Shopping for groceries and other basic needs; and
(4) Services provided by community facilities
and agencies that increase participation in programs, or otherwise promote
independent living.
(b) Contract
agencies providing transportation services shall comply with provisions
included in the contract with regard to routes and reimbursements.
(c) Transportation
services shall be provided in vehicles that are:
(1)
Registered pursuant to Saf-C 500;
(2)
Inspected pursuant to Saf-C 3200, and are in good working order; and
(3)
Insured for personal liability.
(d)
Transportation services shall be provided by individuals who:
(1) Have
a current and valid driver’s license; and
(2) Are employees of a Title III service provider
or other transportation provider, or volunteers under the supervision of a
Title III service provider.
(e) Contract
agencies shall document transportation services provided to the individual on
an operational schedule or on a service provision log that includes:
(1)
The date(s) of service;
(2)
The starting and ending locations;
(3)
The name(s) of the individual(s);
(4)
The reason the transportation services are required;
(5)
The name(s) of the driver; and
(6)
Comment on any follow-up service provided.
(f) Transportation services for individuals
shall not be reimbursed when duplicative of any other program or services, or
when included as a core service under the rate paid to the service provider.
Source. (See Revision Note at part heading for He-E
502) #10530, eff 2-28-14 (formerly He-E 502.32)
PART He-E 503 ALZHEIMER'S RESPITE CARE SERVICE
Statutory
Authority: RSA 161-F:67
He-E 503.01 Purpose. The purpose of the respite care described in
this rule is to provide temporary rest and relief to the primary caregiver from
the demands of care provided to a person with Alzheimer’s disease or a related
disorder at home.
Source. #5584, eff 2-16-93; ss by #5732, eff
10-27-93, EXPIRED: 10-27-99
New. #7799, eff 12-4-02, EXPIRED: 12-4-10
New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
New. #13437, eff 8-19-22
He-E 503.02 Definitions.
(a)
“Adult” means an individual age 18 and older.
(b)
“Alzheimer’s disease and related disorders (ADRD),” means “ADRD” as
defined in RSA 161-F:66, I.”
(c)
“Adult day program” means a facility licensed under RSA 151 and He-P 818.
(d)
“Bureau” means the New Hampshire department of health and human services
bureau of elderly and adult services.
(e)
“Contract agency” means the agency contracted with the bureau to
coordinate ADRD respite care services in accordance with He-E 503.
(f)
“Department” means the New Hampshire department of health and human
services.
(g)
“Eligible person”, pursuant to RSA 161-F:66, II, means an adult who is
unable to attend to personal daily needs without the assistance or continuous
supervision of a primary caregiver due to ADRD.
(h)
“Financial management services agency” means a contract agency that
performs human resources and financial functions in accordance with He-E 503.08.
(i)
“Home health agency” means agencies licensed to provide home health care
pursuant to He-P 809 or He-P 822 or certified as another qualified agency
pursuant to He-P 601.
(j)
“Nursing facility” means an institution or distinct part of an
institution that meets the requirements of Section 1919 of the Social Security
Act 42 USC 1396r.
(k) “Person-centered respite care plan” means a
plan in which the primary caregiver is the center of the system of care and the
primary caregiver’s needs and preferences drive the development and
implementation of the respite care services provided.
(l) “Primary caregiver” pursuant
to RSA 161-F:66, III, means the family member or other natural person
who normally provides the home care and
supervision of a victim of ADRD.
(m)
“Residential care facility” means a facility providing assistance with personal
and social activities at one of the levels of care described in RSA 151:9, VII
and VIII, He-P 804, and He-P 805.
(n)
“Respite care budget” means the amount of funding that is allocated to a
primary caregiver from state general funds allocated to ADRD as part of the
state budget.
(o)
“Respite care provider” means the entity or the individual chosen by the
primary caregiver to provide ADRD respite care services.
(p)
“Respite care services” pursuant to RSA 161-F:66, IV means care provided on an intermittent basis
to the eligible person to relieve the primary caregiver from the demands of
home care for a limited period of time.
(q)
“Spending plan” means a plan developed by the contract agency and
primary caregiver to ensure the primary caregiver’s needs are met and the
entire respite care budget is spent each fiscal year.
(r)
“Waitlist” means a list of individuals with ADRD maintained by the
contract agency who have been determined eligible, and in need of ADRD respite
care services from a contract agency, but the agency does not have sufficient
service units or resources to serve these individuals.
Source. #5584, eff 2-16-93; ss by #5732, eff
10-27-93, EXPIRED: 10-27-99
New. #7799, eff 12-4-02, EXPIRED: 12-4-10
New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
New. #13437,
eff 8-19-22
He-E 503.03 Eligibility.
(a)
To be eligible to receive ADRD respite care services, the individual
requesting respite services shall be:
(1)
The primary
caregiver as defined in He-E 503.02(l); and
(2) Providing unpaid care 24 hours per day, 7 days
per week to an individual with ADRD.
(b)
The individual receiving ADRD respite care services shall be an adult
who:
(1) Is unable to attend to his or her daily needs
without the assistance or continuous supervision of a primary caregiver due to
the impacts of ADRD.
(2) Is not receiving respite services paid
through any of the following sources:
a. A medicaid waiver program;
b. The department of veterans affairs; or
c. Any other program.
Source. #7799, eff 12-4-02, EXPIRED: 12-4-10
New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
New. #13437,
eff 8-19-22
He-E 503.04 Person Centered Respite Care Plan.
(a) If the eligibility requirements in He-E
503.03 are met, the primary caregiver and contract agency shall collaborate to
complete and develop the following:
(1) An
assessment in accordance with (b) below;
(2) A
person-centered respite care plan; and
(3) A
respite care budget in accordance with (e) and (f) below.
(b) The assessment shall include the following
information:
(1) The
primary caregiver’s name, address, and telephone number;
(2) The
name of the eligible person;
(3) The
relationship of the primary caregiver to the eligible person;
(4) Confirmation that the eligible person:
a. Has
received a differential diagnosis of Alzheimer’s disease or a similar
irreversible dementia; or
b. Demonstrates
symptoms of Alzheimer’s disease or a similar irreversible dementia; and
(5) The
primary caregiver’s statement of the
eligible person’s need for respite services.
(c) If the assessment indicates that the
eligibility requirements for ADRD respite service, as described in He-E 503.03,
are not met, the contract agency shall assist the primary caregiver to identify
and explore other helpful resources, such as the social service block grant or
choices for independence programs.
(d) The person-centered respite care plan shall
be based on the completed assessment described in (b) above.
(e) The primary caregiver and the contract agency
shall work to develop the respite care budget based on the needs identified in
(b)(5) above.
(f) To ensure as many primary caregivers as
possible receive respite, the respite care budget shall not exceed $2000 per
primary caregiver annually.
(g) The contract agency shall review the
person-centered respite care plan and respite care budget with the primary
caregiver annually to determine the ongoing respite care service needs.
Source. #7799, eff 12-4-02, EXPIRED: 12-4-10
New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
New. #13437,
eff 8-19-22
He-E 503.05 ADRD Respite Settings.
(a)
ADRD respite care services shall be provided in the following settings:
(1) A home setting;
(2) A community setting, such as a licensed adult
day program; or
(3) A licensed nursing or residential care facility.
(b) ADRD respite care services shall be provided
by:
(1) Nursing
facilities;
(2) Residential care facilities;
(3) Home health agencies;
(4) Adult
day programs; or
(5) Individuals
employed by a contracted financial management services agency as described in
He- E 503.08(a).
Source. #7799, eff 12-4-02, EXPIRED: 12-4-10
New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
New. #13437,
eff 8-19-22
He-E 503.06 Contract Agency Requirements.
(a)
The contract agency shall:
(1)
Receive
inquiries and determine eligibility for ADRD respite services pursuant to He-E
503.03;
(2) Develop, in collaboration with the primary
caregiver:
a. A person centered respite care plan and
respite care budget as described in He-E 503.04; and
b. A spending plan in accordance with He-E 503.07
below;
(3) Identify the primary caregiver’s choice for a
respite setting as described in He-E 503.05; and
(4) Review and modify the ADRD respite plan and
respite care budget with the primary caregiver on an annual basis or more
frequently if necessary to meet the primary caregiver’s needs.
Source. #7799, eff 12-4-02, EXPIRED: 12-4-10
New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
New. #13437,
eff 8-19-22
He-E 503.07 ADRD Spending Plan.
(a) ADRD respite services shall be limited to the
extent that funds, staff, or other necessary resources are available.
(b)
The contract agency shall forward the respite care budget and spending
plan to the financial management services agency.
(c)
The financial management services agency shall pay invoices in
accordance with the respite caregiver and spending plan.
Source. #13437, eff 8-19-22
He-E 503.08 Financial Management Services.
(a) The financial management services agency shall
perform the following human resources functions for individuals working as
respite providers:
(1) Be the employer of record;
(2) Complete tax, labor, and social security
documents;
(3) Verify the individual’s citizenship or that
the individual is legally authorized to work in the United States;
(4) Request a New Hampshire criminal records
background check;
(5) Request a BEAS state registry check in
accordance with RSA 161-F:49; and
(6) Manage timesheets.
(b)
The financial management services agency shall perform the following
financial management functions for individual respite care providers, primary
caregivers, and the eligible person:
(1) Manage and pay invoices for each primary caregiver’s
respite care budget and spending plan;
(2) Monitor respite care budgets allocated to primary
caregivers; and
(3) Provide each contract agency with a monthly
statement showing expenditures of ADRD funds by primary caregivers and any remaining
balances.
Source. #13437, eff 8-19
He-E 503.09 Waitlist.
(a)
The contract agency shall develop a waitlist of eligible primary caregivers
when funding, staff, or other necessary resources are not available to support
the provision of respite services.
(b)
The contract agency shall prioritize participants on the waitlist using
the following criteria:
(1) The declining mental or physical health of the
primary caregiver;
(2) The economic need of the primary caregiver or
the individual with ADRD; and
(3) An increase in the primary caregiver’s responsibilities.
Source. #7799, eff 12-4-02, EXPIRED: 12-4-10
New. #9834, INTERIM, eff 12-18-10, EXPIRES: 6-16-11; ss by #9931, eff 5-26-11; ss by #12781, INTERIM, eff 5-21-19, EXPIRED: 11-18-19
New. #13437, eff 8-19-22 (formerly
He-E 503.08)
He-E 503.10 Waivers.
(a) Contract agencies who wish to
request a waiver of a requirement contained in He-E 503 shall submit a letter
to the bureau on the contract agency’s letterhead through one or more of the
following means:
(1) E-mail to beas@dhhs.nh.gov;
(2) Fax to (603) 271-4643; or
(3) Mail by postal mail to:
The NH
Department of Health and Human Services
Bureau of
Elderly and Adult Services
105 Pleasant
St., Main Building
Concord, NH
03301
(b)
The waiver request shall be signed by the contract agency’s executive
director or designee and shall include:
(1) The specific requirement in He-E 503 that the
contract agency requests be waived;
(2) The reason why the waiver is being requested;
and
(3) The alternative proposed by the contract
agency to satisfy the requirements of He-E 503.
(c)
The department shall review the request, and within 60 calendar days of
the date the request was received, inform the contract agency in writing of the
decision.
(d)
The waiver request shall be approved if the alternative proposed by the
contract agency meets the intent of He-E 503 and does not:
(1) Negatively impact the health or safety of the
eligible person or the primary caregiver;
(2) Affect the quality of services provided; or
(3) Waive any provision or procedure in statute.
(e)
Waivers that are approved shall become effective as of the date of the
written approval in accordance with He-E 503.10(c) above.
(f)
Waivers that relate to the health, safety, or welfare of eligible
persons or primary caregivers shall be effective for the remaining period of
the primary caregiver’s eligibility period and subject to the primary caregiver’s
continued eligibility.
(g)
Contract agencies who wish to request a renewal of a waiver shall
request a renewal at least 90 calendar days prior to the expiration of a
current waiver by following the steps contained in He-E 503.10 (a) through (e)
above.
(h)
Any waiver shall end with the closure of the program or applicable service.
Source. #13437
PART
He-E 504 METHOD OF SERVICE PROVISION -
EXPIRED
Source. #5584, eff 2-16-93; ss by #5732, eff
10-27-93, EXPIRED: 10-27-99
PART
He-E 505 PAYMENT FOR SERVICES
Source. #5584, eff 2-16-93; ss by #5732, eff
10-27-93, EXPIRED: 10-27-99
PART
He-E 506 APPLICATION PROCESS
Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93,
EXPIRED: 10-27-99
PART
He-E 507 SERVICE AGREEMENT
Source. #5584, eff 2-16-93; ss by #5732, eff
10-27-93, EXPIRED: 10-27-99
PART
He-E 508 PLAN OF CARE
Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93,
EXPIRED: 10-27-99
PART
He-E 509 SERVICE RECORD
Source. #5584, eff 2-16-93; ss by #5732, eff
10-27-93, EXPIRED: 10-27-99
PART
He-E 510 MODES OF SERVICE
Source. #5584, eff 2-16-93; ss by #5732, eff
10-27-93, EXPIRED: 10-27-99
PART
He-E 511 EVALUATION AND MONITORING OF SERVICE
PROVISION
Source.
#5584, eff 2-16-93; ss by #5732, eff 10-27-93,
EXPIRED: 10-27-99
PART
He-E 512 REDETERMINATION OF ELIGIBILITY
FOR ADRD RESPITE CARE SERVICE
Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93,
EXPIRED: 10-27-99
PART
He-E 513 TRAINING
Source. #5584, eff 2-16-93; ss by #5732, eff 10-27-93,
EXPIRED: 10-27-99
APPENDIX
Rule |
Specific
State Statute the Rule Implements |
|
|
He-E
501.01-501.27 |
RSA
161-F:4; 42 USC 1397 |
|
|
He-E 502.01-He-E 502.32 |
RSA 161-F:4; 42 USC 3001 et. seq. |
|
|
He-E 503 (Specific Rules implementing specific
statutes are listed below) |
RSA 161-F:65 and RSA 161-F:67 |
He-E 503.01 |
RSA 161-F:65 |
He-E 503.02 |
RSA 161-F:66 |
He-E 503.03 |
RSA 161-F:70,II |
He-E 503.04 |
RSA 161-F:70,V,VI |
He-E 503.05 |
RSA 161-F:65-70 |
He-E 503.06 |
RSA 161-F:69; RSA 161-F:67; RSA 161-F:70,
VII |
He-E 503.07 |
RSA 161-F: 67 |
He-E 503.08 |
RSA 161-F:70, VII |
APPENDIX
B: Incorporation by Reference Information
Rule |
Title |
Publisher; How to Obtain; and Cost |
He-E 501.25(d)(1) |
United
States Department of Agriculture’s “ Dietary Guidelines for Americans
2015-2020” (Eighth Edition) |
Publisher: United States Department of Agriculture Cost: Free to the Public The incorporated document is available at: https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf |
He-E 502.29(c)(1) & He-E 502.30(c) |
US Departments of Agriculture & Health
and Human Services “Dietary Guidelines for Americans, 2010.” |
Available free
of charge at http://www.health.gov/dietaryguidelines/. This publication
can also be ordered by calling the U.S. Government Printing Office (GPO) at
(866) 512-1800 and asking for stock number 001-000-04719-1, or by accessing
the GPO Online Bookstore at http://bookstore.gpo.gov. |
He-E
502.29(d)(1) & He-E 502.30(c) |
US Department of Agriculture & Health
and Human Services “Dietary Guidelines for Americans, 2020-2025.” (Ninth
Edition) |
Publisher: U.S.
Department of Agriculture |