CHAPTER He-W 800 ELIGIBILITY FOR MEDICAL ASSISTANCE
PART He-W 801 RESERVED
PART
He-W 802 PROGRAM COVERAGES AND
LIMITATIONS
He-W 802.03 Telephone Application.
(a) Applicants for any program of medical
assistance except for medical assistance as described in He-W 858.05 and He-W
858.06, who request assistance via the telephone, shall be considered to have submitted an application as described in He-W 601.01(p).
(b) The telephone application process pursuant to
(a) above shall only be available as funding and resources within the current
state fiscal year are available.
(c) All the application requirements that apply
when an individual submits a written application shall apply when an individual
requests assistance via (a) above, including:
(1) Verification requirements described in He-W
806;
(2) Interview requirements described in He-W
636.01 and He-W 644.01; and
(3) All program requirements as described in He-W 800.
Source. #12552, eff 6-20-18
PART He-W 803
INDIVIDUAL RIGHTS AND RESPONSIBILITIES
He-W
803.01 Authorized Representative.
(a) A individual who
chooses an authorized representative (AR), as defined in He-W 601.01(w), to
help with some or all the responsibilities of applying for or receiving medical
assistance shall provide all of the following information in writing:
(1)
The name, address, and telephone number of the AR;
(2)
The duties that the AR will carry out, as specified in (c) below;
(3)
The individual's relationship to the AR;
(4)
A statement signed and dated by the individual acknowledging:
a.
His or her responsibility for any errors, omissions, failures to report
information to DHHS, or inaccurate information reported to DHHS by the AR;
b.
That if the AR uses the individual’s benefits without permission, these
benefits will not be replaced by DHHS;
c.
That the person the individual names as the AR will continue to act for
the individual until the individual or the AR tells DHHS of a change; and
d.
Comprehension of the individual’s choice of AR and the duties assigned
to that AR; and
(5)
A statement signed and dated by the AR:
a.
Agreeing to accept the responsibilities designated by the individual;
b.
Acknowledging that the AR understands that:
1.
Proof of the AR’s identity is required;
2. If
disqualified for a program violation, the person identified as the AR can no
longer act as an AR unless there is no one else suitable to represent the
individual; and
3.
The AR will continue to act as an AR for the individual until the AR or
the individual tells DHHS of a change.
(b) To qualify as an AR, an individual shall be
an adult who has:
(1)
Expressed concern for the individual's wellbeing;
(2)
Sufficient knowledge about the individual's circumstances to assist the
individual in applying for or receiving assistance; and
(3)
The capability to obtain information about the individual's
circumstances.
(c) The individual may authorize an AR to carry
out one or more of the following responsibilities:
(1)
Obtaining DHHS applications and other forms or DHHS paperwork, and
completing these for the individual;
(2)
Attending eligibility interviews for the individual;
(3)
Providing DHHS with verification of the individual's income, resources and other case circumstances;
(4)
Reporting and verifying changes in the individual's case circumstances
to DHHS;
(5)
Receiving the individual's medical assistance identification card and
other DHHS mail;
(6)
Asking for, attending, and representing the individual at administrative
appeals for the individual;
(7)
Communicating with the individual’s managed care organization or qualified
health plan; and
(8) Any other duties regarding eligibility for
medical assistance an individual chooses to designate to an AR.
(d) If designated pursuant to (a)(2) above, ARs
shall:
(1)
Sign DHHS forms completed on behalf of the individual; and
(2)
Co-sign DHHS forms they assist the individual in completing.
Source. #11042, eff 2-24-16
He-W
803.02 Individual Responsibility to
Supply Accurate Information. Individuals
shall supply complete and truthful answers to all written and verbal questions
to establish eligibility or fulfill an eligibility requirement, pursuant to RSA
167:17-b.
Source. #11042, eff 2-24-16
He-W
803.03 Individual Responsibility to
Report Changes. Failure to report
changes no later than 10 calendar days after the change takes place, pursuant
to RSA 167:17, shall result in the recoupment of any resultant overpayments or
a corrective payment for any resultant underpayments.
Source. #11042, eff 2-24-16
PART He-W 804 CASE DECISIONS
He-W
804.04 Electronic Notification.
(a) Notices of decision (NOD), as defined in He-W
601.05(y), may be accessed electronically by the casehead,
as defined in He-W 601.02(j), if the casehead:
(1) Chooses to access NODs electronically;
(2) Has an email
account able to receive notifications from the department;
(3) Provides the
department with his or her email account address; and
(4) Activates an
account through the department’s eligibility web portal.
(b) If the casehead
chooses to access NODs only electronically, no paper NODs shall be sent to the casehead via the mail.
(c)
If the casehead chooses to access NODs only
electronically, the casehead shall be responsible for the security and validity of the email account
information provided to the department.
(d)
All requirements that apply when the casehead
receives a paper NOD shall apply when the casehead
chooses to access NODs only electronically.
(e)
If the casehead prefers to reestablish
generation of paper NODs sent via the mail and chooses not to use the
department’s eligibility web portal to make this change, he or she shall submit a request to the
department in writing and include the following information:
(1) The casehead’s printed name;
(2) The request
to reestablish generation of paper NODs;
(3) The case
number or recipient identification number (RID) assigned to the casehead’s case; and
(4) The casehead’s signature.
(f) The date the department receives
the completed request described in (e) above shall be the individual’s filing
date for the request to reestablish paper NODs.
(g) Paper generation of NODs shall be generated
to the casehead’s mailing address within 10 days of
the individual’s filing date described in (f) above.
Source. #10729, eff 11-25-14
He-W
804.05 Electronic Account Access.
(a) Electronic accounts that contain the casehead’s electronic NODs and other confidential case
information shall be activated through the department’s eligibility web portal
by:
(1) The casehead;
(2) The casehead’s guardian, conservator, or
protective payee;
(3) An
authorized representative or power of attorney chosen by the casehead; or
(4) An
organization acting as the casehead’s guardian, conservator, protective payee, authorized representative, or power of attorney.
(b) If an organization acting as the casehead’s guardian, conservator, protective payee, authorized
representative, or power of attorney chooses to access a casehead’s
electronic account, the organization shall:
(1) Obtain the casehead’s permission to access the electronic account; and
(2)
Register with the department by providing the following information:
a. The
organization’s name, phone number, and street, mailing, and email address;
b. The name of a designated
administrator for the organization who is responsible for maintaining
confidentiality for the entire organization;
c.
A 4-digit pin, chosen by the administrator, for security purposes; and
d. The administrator’s dated signature
signifying an agreement to abide by the confidentiality and safeguarding
information policies, pursuant to RSA 167:31, RSA 167:32, and 42 CFR 431.300-42
CFR 431.307.
(c) A casehead shall
not have access to an electronic account through the department’s
eligibility web portal once the casehead has given
permission to an organization to access the casehead’s
electronic account.
(d)
If the
organization chooses to access NODs only electronically, with no paper NOD mailed,
the organization shall be
responsible for the security and validity of the
email account information provided to the department.
(e)
All requirements that apply when the casehead
receives a paper NOD shall apply when the organization chooses
to access NODs only electronically on behalf of the casehead.
(f)
If the organization prefers
to reestablish generation of paper NODs sent via the mail, the organization
shall do so using the department’s eligibility web portal to make this change.
Source. #10729, eff 11-25-14
PART He-W 805 RESERVED
PART He-W 806 VERIFICATIONS
Revision
Note:
Document
#10743, effective 12-12-14, readopted with amendments He-W 606.89 titled “In
and Out Medically Needy Medical Assistance” and renumbered the rule as He-W
806.89 titled “Verification Requirements for In and Out Medically Needy Medical
Assistance”. The source note information
for He-W 806.89 prior to Document #10743 includes the documents filed under
He-W 606.89.
Although
He-W 606.89 had last been filed under Document #8684, effective 7-21-06, this
rule did not expire on 7-21-14 since it was extended pursuant to RSA 541-A:14-a
until replaced by He-W 806.89 in Document #10743, effective 12-12-14.
He-W 806.01 - 806.17 and He-W 806.19
through He-W 806.36 RESERVED
He-W
806.18 Institutional Residence.
(a) The department of health and human services
(DHHS) shall verify institutional residence and the individual's status within
the institution by written or verbal contact with the institution.
(b) Individuals who received medical assistance
but whose assistance was terminated at the time of admission to New Hampshire
Hospital (NHH) shall have medical assistance redetermined pursuant to He-W
684.01 without a personal interview, as defined in He-W 601.06(l), if the
individual meets the criteria in (c) below.
(c) A personal interview shall not be required of
individuals described in (b) above when the individual:
(1)
Is discharged within 60 days from the date of admission; and
(2)
Provides to DHHS all of
the following information in writing:
a.
Individual’s name, case number, discharge address, and indication of
whether the individual received medical assistance prior to admission to NHH;
b.
Date of admission to and discharge from NHH;
c.
Shelter costs for the non-adult categories of medical assistance;
d.
Assistance group composition of all people that will reside at the
discharge address with the individual, and their relationship to the
individual;
e.
Current income of the individual and all household members;
f. Current resources, pursuant to He-W
601.07(f), of the individual and all household members;
g. Amount and type of any
third-party medical coverage held by the individual and all household members;
h. Any other changes in or information
about case circumstances that would impact eligibility; and
i.
Individual’s or representative’s dated signature acknowledging:
1. That the individual has
reported all changes that have occurred since the individual’s last eligibility
determination and that the information provided to DHHS is true and complete to
the best of his or her knowledge;
2.
That the individual must provide proof of all statements and information
provided to DHHS, and that the individual’s or representative’s signature gives
permission to DHHS to contact other persons or organizations to get additional
proofs of the individual’s eligibility;
3. That any person who intentionally makes a false statement or
misrepresents his or her circumstances or intentionally fails to disclose the
receipt of property, wages, income, or resources, or any changes in
circumstances that would affect his or her initial or continued eligibility for
assistance may be found guilty of violating state law;
4.
That the individual must report any changes in circumstances within 10
calendar days of when the change occurs, or as instructed by DHHS, pursuant to
RSA 167:17; and
5. That if
the individual is not satisfied with any decision made by DHHS, the individual may request
an appeal within 30 calendar days from the date of the notice; and
(3) Provides to DHHS documentation of changes in
address, shelter costs for the non-adult categories of medical assistance,
assistance group composition, income, resources, and medical coverage that have
occurred since the last eligibility determination, within 10 calendar days of
the date of the request.
(d) A personal interview shall be required to
redetermine medical assistance for individuals released from an institution
when:
(1)
An eligibility redetermination was due or overdue when the individual
was admitted to New Hampshire Hospital;
(2)
An eligibility redetermination is due during the month the individual is
discharged from New Hampshire Hospital;
(3)
DHHS determines that the individual failed or refused to cooperate
without good cause pursuant to He-W 601.04(i) with
the medical review process pursuant to He-W 685.01; or
(4)
The individual does not meet the criteria described in (c) above.
Source. #11042, eff 2-24-16
He-W
806.37 Application for Disability
Benefits. In accordance with He-W
652.07(b)(5), the applicant or
recipient shall provide a letter from
the Social Security Administration or provide a form designated by the Social
Security Administration acknowledging the individual has applied for disability
benefits under 42 USC 401-434 or 42 USC 1381-1383f.
Source. #11026, eff 1-23-16
He-W 806.38 - 806.54 RESERVED
He-W
806.55 Deemed Income. Income deemed from a parent or legal guardian
to a minor casehead, when the casehead
lives with the parent or legal guardian, shall be verified in the same manner
as income of an adult category assistance group member, unless otherwise
designated.
He-W 806.56 to He-W 06.59 RESERVED
Source. #13414, eff 7-26-22
He-W
806.60 Verification of Educational
Income - Adult Categories. Acceptable
verification of specific types of educational income shall be provided to the
department, as follows:
(a) For U.S. Secretary of Education scholarships
and grants:
(1) Written or verbal contact with the financial
aid officer at the individual's school; or
(2) A letter of award;
(b) For work/study income:
(1) Written or verbal contact with the financial
aid officer at the individual's school;
(2) Written or verbal contact with the
individual’s employer to obtain earnings information; or
(3) Pay stubs;
(c) For other post-graduate scholarships or
grants:
(1) Written or verbal contact with the financial
aid officer at the individual's school; or
(2) A letter of award;
(d) For veterans' educational assistance benefits:
(1) A written or verbal statement from the
Department of Veterans Affairs;
(2) A letter of award which states the amount and
that benefits are contingent upon regular school attendance; or
(3) A check or check stub to verify the amount;
and
(e) For student loans:
(1) Written or verbal contact with the financial
aid officer at the individual's school; or
(2) A loan agreement or other loan document.
Source. #10699, eff 10-24-14
He-W 806.61 through He-W 806.67 RESERVED
He-W
806.68 Adult OAA, APTD, and ANB
Employment Expense Disregard.
(a)
Verification of employment expenses shall not be required for use in the
cost of care computation for OAA, APTD, or ANB applicants and recipients
requesting nursing facility, choices for independence (CFI), home and
community-based care for the developmentally disabled (HCBC-DD), home and
community-based care for individuals with an acquired brain disorder (HCBC-ABD),
and home and community-based care for in-home supports (HCBC-IHS) assistance,
if the individual's claimed monthly employment expenses are $18.00 or less.
(b)
Acceptable verification of the amount of employment expenses for use in
the cost of care computation for OAA, APTD or ANB applicants and recipients
requesting nursing facility, CFI, HCBC-DD, HCBC-ABD, and HCBC-IHS assistance,
shall be:
(1)
For social security taxes, pay stubs, a letter or other written
information from the employer which specifies the amount of social security
taxes withheld from earnings;
(2)
For railroad retirement, pay stubs or a letter from the employer
verifying the employment expense;
(3)
For federal withholding:
a.
Pay stubs or a letter from the employer verifying the employment
expense; or
b. For self-employed individuals, IRS tax
forms or other documents which indicate the amount of federal withholding taxes
being paid;
(4)
For transportation costs:
a. A
statement signed by the individual indicating whether reimbursement is received
and the amount and source of the reimbursement;
b. If
child care related transportation costs are claimed, a statement signed by the
child care provider attesting to the fact that it is necessary for the
individual to provide the child's transportation;
c.
If the individual's own vehicle is used, a signed statement indicating
the number of miles claimed and that such mileage is the shortest necessary to
travel to and from work;
d.
If the individual rides in another person's privately owned vehicle, the
documentation in c. above, and a statement signed by the driver which indicates
the amount and frequency of the charge for transportation; or
e.
If the individual uses public transportation, a statement signed by the
provider of the transportation which indicates the amount normally charged to
the public and whether the charge is for one-way or round-trip;
(5)
For special clothing, paid receipts for purchased clothing which
substantiate that the costs are recurring; and
(6) For child care costs:
a.
If the individual is being reimbursed for child care costs through the
department of health and human services (DHHS) child care assistance program, the
amount, if any, of the child care fee which the client must pay as shown on the
DHHS invoice; or
b.
If there is no DHHS child care assistance program involvement with child
care costs, acceptable documentation shall be:
1. A
statement signed by the individual indicating whether reimbursement is received
and the amount and source of the reimbursement;
2. A
written statement signed by the child care provider indicating the amount and
frequency of the child care cost; or
3.
DHHS verbal contact with the child care provider indicating the amount
and frequency of the child care cost.
(c)
If the individual fails or refuses to provide verification of a claimed
expense, the amount of the unverified expense shall not be an allowable
employment expense.
Source. #11026, eff
1-23-16
He-W 806.69 Impairment
Related Work Expenses.
(a) When
claiming impairment related work expenses (IRWE’s), APTD applicants and
recipients shall furnish the
department of health and human services (DHHS) with documentation of the need
for and the unreimbursed cost of one or more of the IRWE’s described in 20 CFR
416.976.
(b)
Acceptable documentation of the need for IRWE’s shall be a signed
statement from a physician, psychologist, vocational rehabilitation counselor,
or other medical health professional which:
(1)
Indicates that the expense is related to the applicant or recipient’s
impairment and is necessary for employment; and
(2)
Is dated within 30 days of the date that the documentation is provided
to DHHS.
(c)
Acceptable documentation of the unreimbursed cost of the expense shall
be a paid receipt, canceled check or other documentation that demonstrates that
the applicant or recipient has paid for the item or service out of his or her
own funds, and has not and will not be reimbursed for the expense.
(d)
For an applicant or recipient wishing to claim mileage expenses for his
or her specially equipped vehicle, the applicant or recipient shall provide
documentation of:
(1)
The ownership, make, and model of the vehicle;
(2)
The specific modifications that were made to the vehicle; and
(3)
The number of miles traveled to and from work.
(e)
Refusal or failure to provide verification of an IRWE shall result in
the expense not being allowed as a deduction from earned income.
(f)
OAA recipients with an IRWE deduction at the time their case is
transferred from APTD to OAA shall furnish documentation pursuant to (a) above.
Source. #11026, eff
1-23-16
He-W 806.70 through He-W 806.73 RESERVED
He-W 806.74
Allowable Deductions.
(a)
Acceptable verification of allowable deduction amounts for medical
assistance programs that do not determine income pursuant to 42 CFR 435.603
shall include:
(1) For
training expenses:
a. The
same documentary evidence required under He-W 606.68 for transportation costs,
special clothing, child care costs, and other allowable expenses; and
b. A
letter from an official of the training program which states that the expense
is required and a receipt or other verification showing the amount which is
required to be paid for the expense;
(2) For
court-ordered child support, a copy of the most current court order;
(3) For
court-ordered alimony, a copy of the most current court order;
(4) For
garnishments, a letter from the employer; and
(5) For
incurred current medical expenses and prior medical debts of an individual
residing in a nursing facility:
a.
Provider bills, reminder notices and collection agency notices which are
dated within 30 days of the month to which the debt is expected to be applied;
b. A
statement from the insurance company of the intent to pay covered charges, as
indicated by an explanation of medical benefit;
c. The
medical service provider's bill showing insurance payment;
d.
District office collateral verification by letter or telephone with the
insurance or medical provider of the charges and allowances toward medical
services; or
e.
Historical data previously known to the district office which documents
the amount of the charges and allowances toward recurring medical services.
(b) For
all medical assistance programs, if the individual refuses or fails to provide
verification of a claimed expense, the amount of the unverified expense shall
not be considered an allowable deduction.
Source. #10895, eff
7-22-15
He-W 806.75 through He-W 806.77 -
RESERVED
He-W 806.78 Personal
Property Resources.
(a) For medical
assistance categories that have a resource test:
(1) The following documents shall be used to
verify that a resource is legally unavailable to the applicant or recipient:
a. For irrevocable trust funds, the trust
instrument or agreement;
b. For irrevocable burial funds, the bank account,
agreement, trust instrument, or similar document which clearly states that the
burial funds are not legally available to the individual; and
c. For property in probate, written or verbal
contact with the register of probate in the appropriate county indicating that
the property is currently in probate and legally unavailable to the applicant
or recipient or a letter from the attorney handling the property indicating the
property is legally unavailable to the applicant or recipient;
(2) Acceptable verification of income tax refunds
or lump sum earned income tax credit payments shall be a copy of the tax refund
check or the applicant’s or recipient’s submitted tax return;
(3) Acceptable verification of the value of IRA
and non-contractual Keogh accounts and penalty for early withdrawal shall be a
written statement from the financial institution where the account was issued
indicating the current balance in the account and penalty for withdrawal of the
entire amount in the account;
(4) Acceptable verification of the type of Keogh
account, such as contractual or non-contractual, shall be a written statement
from the individual's employer or the financial institution where the account
was issued indicating whether it involves a contractual relationship with other
individuals and if money can be withdrawn without affecting the other
individuals involved;
(5) Acceptable verification of the face value of
life insurance shall be:
a. The actual policy itself; or
b. Written or verbal contact with the insurance
company when the face value cannot be determined using the actual policy;
(6) Acceptable verification of the equity value
of life insurance shall be determined by written or verbal contact with the
insurance company;
a. Using the cash value or non-forfeiture of
benefits table, if there is no loan on the policy; or
b. Written or verbal contact with the insurance
company, if there is a loan on the policy;
(7) Acceptable verification of lump sum death
benefits shall be a letter of award, written contact with the agency providing
the benefit or with the funeral director arranging for payment of the benefit,
or if written documentation cannot be furnished, department of health and human
services (DHHS) verbal contact with the agency or funeral director;
(8) Acceptable verification of resources
resulting from an accumulation of types of income which are excluded by federal
mandate shall be letters of award, written statements from the source providing
benefits, or, if written documentation cannot be furnished, DHHS verbal contact
with the source providing the benefits;
(9) Acceptable verification of stocks and bonds
shall be the market value of the stock or bond in the financial section of a
current newspaper or, if written documentation cannot be located, DHHS verbal
contact with a stock broker; and
(10) Good faith effort to sell a personal property
asset that cannot be readily converted to cash shall be newspaper clippings or
evidence of other means of advertising showing that the asset is for sale at a
price commensurate with the property’s fair market value.
(b) For verification of resources for medical
assistance categories that have a resource test, the following shall apply:
(1) For equity value of a vehicle:
a. The fair market value of an automobile or
truck shall be verified by using the “trade-in value” in the most recent edition
of the NADA Official Used Car Guide, also known as the “Blue Book”;
b. The fair market value shall not be increased
because of special equipment for the handicapped, low mileage, or optional
equipment;
c. If the applicant or recipient states that the
fair market value in the Blue Book does not apply to the vehicle because of
body damage or other factors, the individual shall present verification of the true
fair market value of the vehicle from an auto dealer or an individual who is
engaged in a vehicle sales or service business; and
d. If a vehicle is custom made, too old, or too
new to be included in the Blue Book, the applicant or recipient shall verify
its fair market value by:
1. Obtaining an appraisal from an automobile
dealer or an individual who is engaged in a vehicle sales or service business;
2. Submitting a tax assessment on the vehicle
indicating its value; or
3. Submitting a newspaper advertisement which
indicates the amount for which like vehicles are being sold;
(2) The applicant’s or recipient’s written
statement shall be acceptable verification of the fact that a vehicle is a junk
vehicle, provided the statement gives an accurate and complete description of
the vehicle's condition; and
(3) Acceptable verification of the fact that farm
machinery and vehicles are necessary for subsistence, maintenance, or
employment shall be a written statement from the applicant or recipient.
(c) Acceptable verification of incurred unpaid
medical expenses for medical assistance shall be bills which substantiate the
amount of unpaid medical expenses that the applicant or spouse have incurred
and that the applicant or spouse is still liable for the unpaid medical
expenses.
Source. #11141, eff
7-22-16
He-W 806.79 –through He-W 806.88 RESERVED
He-W 806.89 Verification Requirements for In and Out
Medically Needy Medical Assistance.
(a)
When requested to do so by the department in
accordance with He-W 878.01, the client shall provide documentation of the
following:
(1) Incurred current medical expenses and
obligated prior medical debts, including those of individuals of a family, as
defined in He-W 601.04(c), or family members, as defined in He-W 601.04(f), who reside in the same living unit as the client or for
whom the client is liable;
(2) Medical services and amounts that are subject
to third party reimbursement or insurance coverage; and
(3) The
relationship between the client and the individual for whom medical expenses
are claimed.
(b)
Acceptable documentation of the above criteria shall include, but not be
limited to:
(1) Provider bills, reminder notices and
collection agency notices which are dated within 30 days of the month to which
the debt is expected to be applied;
(2) A statement from the insurance company of the
intent to pay covered charges, or the medical service provider's bill showing
insurance payment;
(3) Department
collateral verification by letter or telephone with the insurance or medical
provider of the charges and allowances toward medical services;
(4) Historical data previously received by the department which documents the amount of the charges
and allowances toward recurring medical services; and
(5) A birth certificate, baptismal record,
marriage certificate, or other document that establishes the relationship
between the client and the individual for whom medical expenses are claimed.
Source. (See
Revision Note #1 at Chapter heading for He-W 600) #5171, eff 6-26-91; ss by
#5508, eff 12-1-92; ss by #6865, eff 10-3-98; ss by #8684, eff 7-21-06; ss by
#10743, eff 12-12-14 (See Revision Note at Part heading for He-W 806)
He-W 806.90 –through He-W 806.91 RESERVED
He-W 806.92 Telephone Redetermination.
(a)
Current recipients of any program of assistance except for medical assistance
as described in He-W 858.05 and He-W 858.06, who reapply for assistance via the
telephone, shall be considered to have requested a redetermination as described
in He-W 684.01(a).
(b)
The telephone redetermination process pursuant to (a) above shall only
be available as funding and resources within the current state fiscal year are
available.
(c)
All general, categorical, technical, and financial requirements that
apply when eligibility for assistance is redetermined whether based on federal or
state law, federal regulation, or published department rules, shall apply when
an individual requests a redetermination pursuant to (a) above.
Source. #12714, eff
1-23-19
PARTS He-W 807 through He-W 815
He-W
816.02 Eligibility of Qualified Aliens. As long as all other
eligibility requirements are met, medical assistance shall be provided to
qualified aliens as defined in 8 USC 1641(b), under the following conditions:
(a) The
qualified alien entered the United States with a status within the meaning of
the term “qualified alien” before August 22, 1996; or
(b) For
qualified aliens who enter the United States on or after August 22, 1996, a period
of 5 years has elapsed since the date of the alien’s entry into the United
States with a status within the meaning of the term “qualified alien.”
Source. #13526, EFF
1-24-23
PARTS He-W 817 through He-W 819 RESERVED
PART He-W
820 ASSET TRANSFERS
He-W 820.01 Purpose. These rules describe the treatment of
transfers of assets. When an individual
applies for or receives nursing facility (NF), medical assistance or any
category of home and community based care (HCBC) waiver services, the
department of health and human services (DHHS) will use these rules to
determine if that individual transferred, assigned, or disposed of the
ownership of an asset within the look back period in accordance with 42 USC
1396p(c).
Source. #12217, eff
6-22-17
He-W
820.02 Definitions. As used in this section, the following terms
shall have the meanings
indicated:
(a)
“Assets” means “assets” as defined in 42 USC 1396p(h)(1), that is, all
income and resources of the individual and of the individual’s spouse. The term includes any income or resources to
which the individual or the individual’s spouse is entitled but does not
receive because of any action by the individual, the individual’s spouse, or a
person, including a court, or administrative body with legal authority to act
in place of or on behalf of the individual, or the individual’s spouse, or any
person, including a court or administrative body, acting at the direction or
upon the request of the individual, or the individual’s spouse.
(b) “Fair market
value” means the current market value of an asset at the time the asset is
transferred. The current market value is
the selling price for which it can reasonably be expected to sell on the open
market in the geographic area involved.
(c) “Home and
community based care (HCBC)” means community services that individuals might
need in order to prevent institutionalization as described under subsection (c) or
(d) of Section 1915 of the Social Security Act.
(d) “Income” means
“income” as described in 42 USC 1382a of the Social Security Act. The term
includes both earned and unearned income.
(e) “Institution” means a hospital, nursing
facility, intermediate care facility for individuals with intellectual
disabilities, or any other provider which is an institution as defined by 42 CFR
435.1010.
(f)
“Institutionalized individual” means any individual
who is an inpatient in a nursing facility, including an intermediate care
facility for individuals with intellectual disabilities, or who is an
in-patient in a medical facility and is receiving a level of care provided in a
nursing facility, or who is receiving care, services, or supplies pursuant to a
waiver under subsection (c) or (d) of Section 1915 of the Social Security Act.
(g) “Penalty period” means the period of time in
which an individual is ineligible for institutional or HCBC waiver services due
to a transfer of an asset for less than fair market value.
(h) “Resources” means
“resources” as described in 42 USC 1382b of the Social Security Act, except
for, in the case of an institutionalized individual, the homestead exclusion provided for in
subsection (a)(1) of that section.
(i)
“Transfer” means any action or failure to act which has the effect of
changing an ownership interest in an asset from the individual to another person,
or preventing an ownership interest the individual would have otherwise
enjoyed. A transfer includes any direct
or indirect method of disposing of an interest in an asset.
(j) “Unearned income”
means all contributions, payments, pensions, benefits, loans, awards, or other
income which is not received as compensation for work performed.
(k) “Valuable
consideration” means that an individual received in exchange for his or her
right or interest in an asset some act, object, service, or other benefit which
is tangible and has intrinsic value to the individual that is roughly equivalent to or
greater than the value of the transferred asset.
Source. #12217, eff
6-22-17
He-W 820.03 Asset
Transfers.
(a) Asset transfers
described in this rule shall:
(1) Be in addition to
and shall not supersede transfers described in 42 USC 1396p(c)(2)(A), (B), (C),
and (D);
(2) Include every type
of income and resource, unless otherwise noted in this rule; and
(3) Apply to transfers
made by:
a. Individuals applying for or receiving nursing facility
(NF) medical assistance or any category of HCBC services furnished under a
waiver granted under 42 USC 1396n(c), pursuant to He-W 856.01(d); and
b. The individual’s
spouse.
(b) Pursuant to 42 USC
1396p(c)(2)(A)(iv), DHHS shall not penalize the transfer of an individual’s
primary residence to his or her child if the child resided in the individual’s
home for a period of at least 2 years immediately before the date the
individual became an institutionalized individual, and the child provided care
to such individual which permitted such individual to reside at home on a
continuous basis rather than in such an institution or facility.
(c) The individual in
paragraph (b) shall provide the following verifications:
(1) At least one
letter signed by a medical professional who cared for the individual prior to
admission to the medical institution stating that the child provided the kind
and quality of care necessary to maintain the individual at home rather than in
a medical institution for at least 2 years immediately before the individual’s
admission to the medical institution;
(2) A statement from
the child describing the type or level of care provided; and
(3) Medical records
consistent with the information described in (b) above.
(d) Pursuant to RSA 167:4, I(b) and 42 USC
1396p(c)(1), a transfer of assets shall
be considered to have been made if, within 60 months prior to the date of
application or at any time while receiving NF medical assistance or any category
of HCBC waiver services, the individual or the individual’s spouse:
(1) Takes action that
reduces or eliminates an individual's ownership or control of such assets;
(2) Gives another
person access to the asset through joint ownership and any action is taken,
either by the individual or by any other person, that reduces or eliminates
such individual's ownership;
(3) Executes an
instrument to transfer title of an asset to another person at a future date and
delivers the instrument to the person who is to receive title;
(4) Transfers title or
ownership of the individual’s home, or its associated land, to another person
or entity;
(5) Transfers title of
real property, including income-producing real property;
(6) Transfers assets
into an irrevocable trust or similar legal device, from which no payment could
under any circumstances be made to the individual;
(7) Obtains a reverse
mortgage, a home equity conversion mortgage, or a similar loan on any home or other real property and transfers
the proceeds to another person;
(8) Is entitled to an
asset but does not receive the asset because of action:
a. By the individual
or the individual's spouse;
b. By a person,
including a court or administrative body, with legal authority to act in place
of or on behalf of the individual or such individual's spouse; or
c. By any person,
including any court or administrative body, acting at the direction or upon the
request of the individual or such individual's spouse;
(9) Purchases a
promissory note, loan, or mortgage, unless such note, loan, or mortgage:
a. Provides a
repayment term that is actuarially sound pursuant to (j)(3) below;
b. Provides for
payments to be made in equal amounts during the term of the loan with no deferral
and no balloon payments; and
c. Prohibits the
cancellation of the balance upon the death of the lender; or
(10) Purchases a life
estate interest in another individual’s home, unless they have resided in the
home for a period of at least one year after the date of the purchase.
(e) Actions by the
individual or the individual’s spouse which would cause income or resources not
to be received shall include but not be limited to:
(1) Irrevocably
waiving pension income or any other form of income;
(2) Waiving an inheritance;
(3) Not accepting or
accessing injury settlements, judgments, or court awards;
(4) Diverting of tort
settlements by the defendant into a trust or similar device to be held for the
benefit of the plaintiff; or
(5) Refusal to take
legal action to obtain a court ordered payment that is not being paid, such as
child support or alimony, unless the individual is being, has been, or is at
risk of being, battered or subjected to extreme cruelty as described in 42 USC
608(a)(7)(c) and corroboration is
provided by the documentation described below including a:
a. Court, medical,
criminal, child protective services, psychological, or law enforcement record,
or a statement from a social service provider;
b. Written statement
from a social worker from a public or private social service agency; or
c. Sworn statements
from an individual with knowledge of the circumstances.
(f) For individuals
applying for or receiving medical assistance, the department of health and
human services (DHHS) shall evaluate asset transfers to determine if the
individual derived fair market value, as defined in He-W 820.02(b) above, from
the transfer.
(g) DHHS shall evaluate
the transfer to determine if the individual derived fair market value, as defined
in He-W 820.02(b) above, whenever an individual applying for or receiving
medical assistance has transferred, assigned or disposed of title or ownership
of an otherwise excluded home to another individual or entity.
(h) Asset transfers
from which the individual receives fair market value or other valuable
consideration shall require no further evaluation for asset transfer.
(i)
A transfer of assets for love and consideration, or which is made for
similar reasons, shall not be considered to be a transfer for fair market
value.
(j) A transfer of
assets to a relative for care provided in the past shall not be a transfer for
fair market value. Although relatives
may be legitimately paid for providing care, any services provided for free in
the past shall be assumed to have been intended to have been provided without
compensation unless it can be rebutted with tangible evidence that a
compensation arrangement had been agreed to in writing at the time services
were provided.
(k) When determining
whether an individual has received fair market value for a transfer when a life
estate has been established, DHHS shall:
(1) Determine what the
fair market value of the asset was at the time of transfer;
(2) Take into account
the individual’s age at the time of the transfer; and
(3) Calculate the
value of the life estate using the life estate tables found in the Supplemental
Security Income (SSI) Program Operations Manual System (POMS), section SI
01140.120 as follows:
a. The life estate
value shall be established by multiplying the market value of the asset by the
life estate factor that corresponds to the individual’s age at the time of the
transfer;
b. The value of the
life estate shall be subtracted from the value of the asset transferred; and
c. The difference between
the value of the life estate and the amount the individual was reimbursed for
the remainder interest shall be the portion of the asset transferred for less
than fair market value.
(l) When determining
whether an individual or spouse has received fair market value for a transfer
of assets into an annuity, DHHS shall:
(1) Determine the fair
market value of the asset at the time of transfer into the annuity;
(2) Determine if the
expected return on the annuity is commensurate with a reasonable estimate of
the life expectancy of the beneficiary to determine whether the annuity is
actuarially sound;
(3) Use the life
expectancy tables published by the office of the chief actuary of the social
security administration, pursuant to 42 USC 1396p(c)(1)(G)(ii)(II);
(4) Determine that the
individual has received fair market value for the annuity if the average number
of years of expected life remaining for the individual coincides or exceeds the
life of the annuity; and
(5) Determine that the
individual did not receive fair market value for the annuity if the average
number of years of expected life remaining for the individual is less than the
life of the annuity.
(m) The background
information of the asset transfer shall be evaluated further to determine if
assets might have been transferred for purposes of qualifying for medical
assistance if DHHS determines that the individual did not receive fair market
value from the transfer.
(n) Factors to be
evaluated in assessing asset transfers referred to in (l), shall include:
(1) Timeframes between
the transfer of assets and the date of application;
(2) The individual's
health at the time of the transfer; and
(3) The individual's
economic situation at the time of the transfer.
(o) The transfer shall
be considered questionable if the evaluation of background information of the
transfer suggests that the individual transferred assets for purposes of
qualifying for medical assistance or results in qualifying earlier than
otherwise would have been possible if the individual had retained all of the
asset(s).
(p) The individual
shall provide additional information and documentation to DHHS upon request to
demonstrate that assets were not transferred for purposes of qualifying for
medical assistance, if the transfer is considered questionable.
(q) Reasons for
transferring assets for purposes other than qualifying for medical assistance
shall include:
(1) The individual
transferred the asset to prevent foreclosure or sale of the asset by the lien
holder, thus preventing total loss of the asset;
(2) The individual
transferred the asset for self-support because the individual's income and
resources were insufficient to meet basic needs or to maintain upkeep of the
asset, such as taxes and repairs, and the individual's basic needs were
provided for in return for the transfer, or the individual lived off the
proceeds of the asset;
(3) The individual
transferred the asset to meet the terms of a written agreement, including debts
arising from such agreement;
(4) The individual
transferred the asset to meet the terms of an oral agreement, including debts
arising from such agreement;
(5) The individual is
not able to afford to take the necessary action to obtain the asset or the cost
of obtaining the asset is greater than the asset is worth, resulting in a case
of failure to cause assets to be received; or
(6) The individual is
being, has been, or is at risk of being battered or subjected to extreme
cruelty as described in 42 USC 608(a)(7)(c) and as corroborated by the
documentation described He-W 820.01(d)(5).
(r) The burden of
proof for substantiating the fact that assets were not transferred for purposes
of qualifying for medical assistance shall rest with the individual.
(s) If the individual
refuses or fails to prove that assets were not transferred for purposes of
qualifying for medical assistance, DHHS shall determine that the assets were
transferred for the purposes of qualifying for medical assistance and the
individual shall be ineligible pursuant to (s) below for the following
institutionalized care:
(1) Nursing facility
services;
(2) A level of care in
any institution equivalent to that of nursing facility services; and
(3) HCBC furnished
under a waiver granted under 42 USC 1396n(c).
(t) To determine the
number of months of ineligibility for the services described in (r) above for
an individual who has transferred property for purposes of qualifying for
medical assistance the following methodologies shall be used:
(1) The penalty period
start date for all individuals who transfer assets for less than fair market
value to make themselves eligible for medical assistance as of February 8, 2006,
shall be whichever is later:
a. The first day the
individual met all other eligibility criteria and would be eligible but for the
transfer, provided that the date does not occur during an existing penalty
period as described in (4) below; or
b. The first day of a
month after which assets have been transferred provided that the date does not
occur during an existing penalty period as described in (4) below;
(2) When an individual
or an individual’s spouse makes multiple fractional transfers of assets in more
than one month for less than fair market value, the penalty shall be based on
the total cumulative uncompensated value of all such transfers, pursuant to 42
USC 1396p(c)(1);
(3) The penalty period
shall be based solely on the value of the assets transferred;
(4) When a countable
transfer takes place during an existing penalty period, a new penalty period
shall not begin until the existing penalty period has expired;
(5) When an individual
makes a series of transfers within one month, the total value of the individual
transfers for the month shall be used to calculate the penalty;
(6) The penalty period
shall be the number of months equal to:
a. The uncompensated
value of assets transferred by the individual, divided by the average statewide
monthly nursing facility private rate; and
b. The average
statewide daily nursing facility rate shall be established by dividing the
average statewide monthly nursing facility private rate, as determined and
updated annually by the division's bureau of audits and rate setting, by 30.42;
(7) When the penalty
period consists of any number of full months and a partial month, the partial
month penalty period shall apply in accordance with (9) below;
(8) When the amount of
the transfer is less than the average statewide monthly nursing facility
private rate, a partial month penalty shall apply;
(9) To determine the number of days the partial month penalty
shall be in effect, the uncompensated value of assets transferred by the
individual shall be divided by the average daily nursing facility rate
described in (6)b. above;
(10) When assets have
been transferred so that the penalty periods overlap, the individual penalty
periods shall be calculated and imposed sequentially;
(11) When multiple
transfers are made in such a way that the penalty period for each transfer will
not overlap, each transfer shall be treated as a separate event, each with its
own penalty period;
(12) When a spouse of
an individual transfers an asset that results in a penalty for the individual,
the penalty period shall be apportioned between the spouses when:
a. The spouse either
is, or becomes, eligible for medical assistance;
b. A penalty could be
assessed against the spouse; and
c. Some portion of the penalty against the individual remains
at the time the above conditions are met;
(13) When the penalty
period for an individual is interrupted due to the death of the individual
or the individual’s discharge from
institutionalized care, the remaining penalty period in (12) above, which is
applicable to both spouses shall be served by the remaining spouse; and
(14) A penalty period
imposed for a transfer of assets shall run continuously from the first date of
the penalty period, regardless of whether the individual remains
institutionalized.
(u) A penalty shall
not be assessed for transfers of assets for less than fair market value under
any of the following circumstances:
(1) The individual
intended, and attempted to dispose of the asset either at fair market value or for
other valuable consideration, and circumstances caused the individual to transfer
the asset for less than fair market value;
(2) The individual
transferred the assets for a purpose other than to qualify for medical
assistance; or
(3) All of the assets
transferred for less than fair market value have been returned to the individual.
(w) Individuals
claiming that circumstances caused the asset to be transferred for less than
fair market value pursuant to (u)(1) above, shall provide documentation of:
(1) The individual’s
attempt to dispose of the asset at fair market value, or for other valuable
consideration; and
(2) The value at which
the asset was disposed.
(x) Individuals
claiming that assets were transferred for a purpose other than to qualify for
medical assistance pursuant to (u)(2) above, shall provide documentation of:
(1) The specific
purpose for which the asset was transferred; and
(2) The reason it was
necessary to transfer the asset for less than fair market value or other valuable
consideration.
(y) If a penalty was
assessed for transferring an asset for less than fair market value or other
valuable consideration and the asset was returned to the individual, then DHHS
shall:
(1) Generate a
retroactive adjustment back to the beginning of the penalty period if the
individual met all other eligibility criteria; or
(2) Redetermine the
penalty period pursuant to (s) above, when only part of an asset, or its
equivalent value, has been returned.
(z) Asset transfer
penalties shall not be imposed due to undue hardship pursuant to RSA 167:4,
III-a and 42 USC 1396p(c)(2)(D).
Source. #12217, eff
6-22-17
PART He-W 821
TECHNICAL REQUIREMENTS FOR NURSING FACILITY (NF) AND HOME AND COMMUNITY
BASED CARE (HCBC) SERVICES
Revision Note:
Document
#12217, effective 6-22-17, readopted with amendments He-W 621 titled “Technical
Requirements for Nursing Facilities (NF) and Home and Community Based Care
(HCHC) Services” and renumbered the rule as He-W 821 titled “Technical
Requirements for Nursing Facility (NF) and Home and Community Based Care (HCHC)
Services”. The source note information
for the rules He-W 821.01 through He-W 821.03 in He-W 821 prior to Document
#12217 includes the documents filed under He-W 621.01 through He-W 621.03,
respectively.
He-W 821.01 Asset
Transfer Penalty Undue Hardship Waiver.
(a) As used in this
section, the following terms shall have the meanings indicated:
(1) “Discharge” means
“discharge” as defined in RSA 151:19, I-a, namely, the “movement of a patient
from a facility to a non-institutional setting or the termination of services
by a home health care provider when the discharging facility or home health
care provider ceases to be legally responsible for the care of the patient”;
(2) “Good cause” means
any circumstance beyond a person’s control that prevents that person from
complying with a requirement, including:
a. A death in the
person’s immediate family;
b. Personal injury or
serious illness of the person or an immediate family member; or
c. Another compelling
reason or justification;
(3) “Individual” means
the person who applied for or is receiving services from the nursing facility
(NF) or under the home and community based (HCBC) waiver program.
(4) “Necessities of
life” means those things a person needs to live, including but not limited to,
heat, hot water, electricity, gas service, or cooking fuel;
(5) “Sworn statement”
means a statement made under oath or affirmation reciting facts which are
personally known by the signer, and which are sworn to or affirmed and
notarized by either a notary public or justice of the peace; and
(6) “Undue hardship”
means a hardship that imposes an unreasonable or disproportionate burden on the
individual, as described in RSA 167:4, III-a, and 42 USC 1396p(c)(2)(D).
(b) Requests for an
asset transfer penalty undue hardship waiver shall include all of the
following:
(1) The individual’s
name, address, and telephone number;
(2) The name, address,
telephone number, and relationship to the individual, of the individual’s legal
guardian, authorized representative (AR), power-of-attorney, or attorney, if
any;
(3) Identification of
the specific reason(s) for the request for an asset transfer penalty undue
hardship waiver from the following list:
a. The asset
was transferred by a person representing the individual and it can be
demonstrated that the individual lacked the mental capacity to comprehend the
disqualifying nature of the transfer;
b.
The application of the asset transfer penalty would result in the
individual being deprived of, and otherwise unable to obtain, necessary care
such that the individual’s health or life would be endangered; and
c.
The application of the asset transfer penalty would result in the
individual being deprived of, and otherwise unable to obtain, food, clothing,
shelter, and/or other necessities of life; and
(4) The printed name
and dated signature of the individual, or, if filed by the individual’s agent
or representative, the printed name and dated signature of the agent or
representative, and their relationship to the individual.
(c) A request for an
asset transfer penalty undue hardship waiver shall include the following attachments:
(1) If the request for an undue hardship waiver was filed by
the individual’s agent or representative, a copy of the legal documentation
shall be provided that authorizes the agent or representative to act on behalf
of the individual, such as an authorized representative declaration, court
order appointing a guardian, power of attorney, etc.;
(2) The following
verifications shall be required in all cases in the form of written
documentation or other evidence that a good faith effort was made to recover
the asset(s) transferred or to make the asset(s) available to the individual,
such as, but not limited to:
a. Any written request
for the asset(s) to be returned to the individual;
b. Any demand
letter(s);
c. Any response
letter(s) from any recipient of the transferred asset(s);
d. Any documents or
other evidence showing that legal action has been initiated to recover the
asset(s); or
e. Any document or
other evidence that demonstrates that action has been taken to recover the
asset(s) or to make the asset(s) available to the individual to help pay for
the cost of the individual’s stay in the NF or to pay for HCBC services;
(3) The following
verifications shall be required if the request for an asset transfer penalty
undue hardship waiver is based upon a claim that the individual lacked the
mental capacity to comprehend the disqualifying nature of the transfer,
pursuant to (b)(3)a. above:
a. A written, dated,
and signed statement from a licensed physician stating that the individual was
mentally incapacitated at the time of the transfer, along with supporting medical
records or an order of findings from a probate court concerning the
individual’s competency at the time of the transfer; and
b. Financial records
that demonstrate that the asset(s) was transferred by the individual’s agent or
representative.
(4) The following
verifications are required if the request for an asset transfer penalty undue
hardship waiver is based upon a claim that the individual’s health or life will
be endangered pursuant to (b)(3)b. above:
a. For NF services:
1. A dated and signed
statement from the NF that documents:
(i)
The individual is currently residing in the NF;
(ii) The individual’s
current arrearage owed to the NF; and
(iii) The monthly
amount currently being paid to the NF by the individual;
2. A sworn, signed, and
dated statement from the individual or the individual’s agent or representative
that documents:
(i)
The individual lacks the income and resources to pay for the NF services
and documentation of what measures have been taken to explore alternatives for
payment; and
(ii) A list of the
individual’s health insurance(s) plan coverage;
3. A signed and dated statement from a licensed physician or
licensed nurse practitioner that documents:
(i)
He or she is the individual’s primary care provider (PCP);
(ii) The specific
services that the individual requires and receives in the NF;
(iii) Services that the
individual would need if discharged from the NF;
(iv) The specific needs
of the individual that cannot be met in the community if the individual is
discharged from the NF;
(v) A brief
explanation of the consequences to the individual if deprived of NF services
and why the individual’s life or health will be endangered; and
(vi) Appellant’s
diagnoses, his or her prognosis, and the severity of his or her condition; and
4. Evidence that the
NF has, in good faith, initiated the process to discharge the individual due to
a lack of payment; and
b. For HCBC services
documents that show the individual lacks the income and resources to pay for
the HCBC services, as follows:
1.
For applicants a statement dated and signed by the individual’s PCP that
documents:
i. The medical services that the individual
requires;
ii. A brief
explanation of why the imposition of an asset transfer penalty will deprive the
individual of medical care such that the individual’s life or health will be
endangered; and
iii. A list of the
individual’s health insurance(s) plan coverage; or
2. For recipients a
statement dated and signed by the individual’s PCP that documents:
i. The medical services that the individual
requires;
ii. The services that the individual will lose if the asset
transfer penalty is imposed, if any;
iii. A brief explanation
of why the imposition of an asset transfer penalty will deprive the individual
of medical care such that the individual’s life or health will be endangered;
and
iv. A list of the
individual’s health insurance(s) plan coverage; and
(5) The following
verifications shall be required if the request for an asset transfer penalty
undue hardship waiver is based upon a claim that the individual will be
deprived of food, clothing, shelter, or other necessities of life pursuant to
(b)(3)c. above:
a.
A signed and dated statement from the individual, or the individual’s
agent or representative, explaining how the imposition of a penalty period will
result in the deprivation of food, clothing, shelter, or other necessities of
life; and
b. Signed and dated
statements from the NF or HCBC service providers describing the specific services
that the individual needs to avoid being deprived of food, clothing, shelter,
or other necessities of life.
(d) Requests for an
asset transfer penalty undue hardship waiver, including required verifications,
shall be filed no later than 30 calendar days from the date on the notice of
asset transfer penalty.
(e) Upon receipt of a
request for an asset transfer penalty undue hardship waiver, the department of
health and human services (DHHS) shall:
(1) Review the
request, attachments, verifications, and any other supporting documentation
provided with the request;
(2) Determine whether
the request establishes that the individual will suffer an undue hardship if
the asset transfer penalty is imposed; and
(3) Notify the
individual, or the individual's agent or representative who submitted the
request for an asset transfer penalty undue hardship waiver, of DHHS' decision
on the request, including the individual's appeal rights.
(f) Failure to comply
with the requirements for an asset transfer penalty undue hardship waiver
request shall result in the request being denied, unless DHHS determines that there
was good cause for the non-compliance.
Source.
#9136, eff 4-22-08; ss by #11058, INTERIM, eff 3-24-16, EXPIRED: 9-20-16
New.
#12217, eff 6-22-17 (See Revision Note at Part heading for He-W 821)
He-W 821.02 Hardship
Waiver for Individuals with Substantial Home Equity.
(a) To request a
waiver of being denied for or terminated from NF or HCBC services due to excess
home equity pursuant to He-W 856.05(d), the individual shall:
(1) Submit a request
for a waiver of the eligibility criteria described in He-W 856.05(d), pursuant
to (b) below; and
(2) Identify the
specific reason(s) for the request from the following list:
a. Being denied for or
terminated from NF or HCBC services due to excess home equity would result in
the individual being deprived of, and otherwise unable to obtain, necessary
care such that his or her individual’s health or life would be endangered; and
b. Being denied for or
terminated from NF or HCBC services due to excess home equity would result in
the individual being deprived of, and otherwise unable to obtain, food,
clothing, shelter, and/or other necessities of life.
(b) The requests for a
waiver described in (a) above shall include all of the following:
(1) The individual’s
name, address, and telephone number;
(2) Identification of
the specific reason(s) for the undue hardship waiver request, pursuant to
(a)(2) above;
(3) The name, address,
telephone number, and relationship to the individual of the individual’s legal
guardian, authorized representative (AR), power-of-attorney, or attorney, if
any; and
(4) The printed name
and dated signature of the individual or, if filed by the individual’s agent or
representative, the printed name and dated signature of the agent or
representative, and their relationship to the individual.
(c) A request for a
waiver described in (b) shall include all required verification pursuant to (f)
and (g) below.
(d) The date the
department of health and human services (DHHS) receives the completed request
described in (b) and (c) above, shall be the individual’s filing date for a
waiver.
(e) The filing date
pursuant to (d) above shall be no later than 30 calendar days from the date on
DHHS’ notice of a denial or termination of NF or HCBC services.
(f) Individuals shall
verify the undue hardship described in (a)(2)a. above by submitting the documentation
described in He-W 821.01(c)(1) and:
(1) He-W
821.01(c)(4)a. for NF services; or
(2) He-W
821.01(c)(4)b. for HCBC services.
(g) Individuals shall
verify the undue hardship described in (a)(2)b. above by submitting the
documentation described in He-W 821.01(c)(1) and:
(1) A signed and dated
statement from the individual, or the individual’s agent, or representative,
explaining how the imposition of a penalty period due to home equity exceeding
the limit will result in the deprivation of food, clothing, shelter, or other
necessities of life; and
(2) A signed and dated
statement from the NF or HCBC service providers describing the specific
services that the individual must retain to avoid being deprived of food,
clothing, shelter, or other necessities of life.
(h) Upon receipt of a
request for a hardship waiver, DHHS shall:
(1) Review the
request, attachments, and any other supporting documentation provided with the
request;
(2) Determine whether
the request establishes that the individual will suffer an undue hardship if
the excess home equity penalty is imposed; and
(3) Notify the
individual, or the individual's agent or representative who submitted the
request, of DHHS' decision on the request.
(i)
Failure to comply with the requirements for the waiver request will
result in the request being denied, unless DHHS determines that there was good
cause for the non-compliance.
Source.
#9136, eff 4-22-08; ss by #11058, INTERIM, eff 3-24-16, EXPIRED: 9-20-16
New.
#12217, eff 6-22-17 (See Revision Note at Part heading for He-W 821)
He-W 821.03 Administrative
Appeals. Individuals denied waivers
described in He-W 821.01 and He-W 821.02 may appeal the department of health
and human services’ decision and request an administrative appeal pursuant to
He-C 200.
Source.
#9136, eff 4-22-08; ss by #11058, INTERIM, eff 3-24-16, EXPIRED: 9-20-16
New.
#12217, eff 6-22-17 (See Revision Note at Part heading for He-W 821)
PARTS He-W 822 through He-W 823 - RESERVED
PART
He-W 824 INSTITUTIONAL RESIDENCE
He-W
824.01 Institutional Residence.
(a) The following individuals shall not be
considered inmates of public institutions or private institutions primarily
engaged in treating mental or emotional disorders or tuberculosis:
(1)
Individuals who are admitted to the New Hampshire Hospital for purposes
of evaluation only, for a period not to exceed 3 months;
(2)
Individuals who, while remaining under the general supervision of a
public institution as an official inmate of that institution, physically reside
outside the institution;
(3) Individuals under age 22 or age 65 or
older who are certified for care at a designated receiving facility as defined
in He-M 405.02(f);
(4)
Patients at the psychiatric unit of the Dartmouth - Hitchcock Medical Center;
(5)
Children in placement in foster homes or other approved child caring
institutions;
(6) Children who participate in the special
education program at the Sununu Youth Services Center;
(7)
Adults in residential care facilities and community living residences;
and
(8)
Inmates committed by a court order to a NH correctional facility, who
require inpatient care at a medical institution as defined in 42 CFR 435.1010.
(b) Individuals who are patients at the Glencliff
nursing facility unit of the New Hampshire Hospital shall be considered as
residing in a nursing facility.
Source. #11042, eff
2-24-16
PARTS He-W 825 through He-W 829
PART He-W
830 LIVING WITH A SPECIFIED RELATIVE
He-W 830.01 Living with a Specified Relative.
(a)
For purposes of determining the assistance group for parent caretaker relative
medical assistance, "dwelling" means:
(1)
An individual's principal residence or place of abode;
(2) The family setting maintained or in the
process of being established as a home, as evidenced by assumption,
continuation, and exercise of responsibility for day-to-day care and control of
the child by the relative with whom the child is living; and
(3) A living unit as defined in (1) and (2) above
with no more than one postal address.
(b)
If the dwelling has a separate living unit attached to it with a
separate postal address, this living unit shall not be considered part of the
same dwelling.
(c)
The department shall consider a child to be living with a specified
relative as defined in RSA 167:78,XXIII when the child lives in the same
dwelling as defined in (a) above as the specified relative unless the
conditions in (e) apply.
(d)
The department shall consider the specified relative in (c) above to be
the casehead for the assistance group.
(e)
If a child lives in the same dwelling as both the child's parent and a
non-parent specified relative, the department shall consider the child to be
living with the parent.
(f)
The department shall consider the parent in (e) above to be the casehead in the assistance group unless the conditions in
(g) below apply.
(g)
If the non-parent specified relative in (e) above is the legal guardian
of the child pursuant to RSA 169-C:3,XIV, the department shall:
(1) Consider the non-parent specified relative to
be the casehead in the assistance group; and
(2) Consider the parent to be a member of the
assistance group pursuant to RSA 167:79,II and He-W 601.01(u).
Source. #13415, eff 7-26-22
PART
He-W 837 GRANITE ADVANTAGE HEALTH CARE
PROGRAM
He-W
837.01 Definitions.
(a) “Beneficiary” means an individual determined
eligible for the granite advantage health care program.
(b) “Commissioner” means the commissioner of the
NH department of health and human services, or his or her designee.
(c) “Community engagement requirement” means a
condition of continuing eligibility for the granite advantage health care
program that requires beneficiaries to engage in 100 hours per calendar month
in one or more community engagement activities.
(d) “Cure” means meeting the community engagement
requirement by making up deficit hours, demonstrating good cause for deficit
hours, or providing certification of an exemption status.
(e)
“Dating violence” means violence committed by a person who is or has been in a
social relationship of a romantic or intimate nature with the victim.
(f) “Deficit hours” means the number of hours below
100 hours that the beneficiary did not participate in community engagement
activities in a calendar month.
(g) “Department” means the New Hampshire
department of health and human services.
(h) “Disability” means disability as defined by
the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation
Act, or Section 1557 of the Patient Protection and Affordable Care Act.
(i) “Disenrollment”
means the termination of medicaid eligibility at the
annual redetermination of a suspended beneficiary.
(j) “Domestic violence” means domestic violence
as defined in RSA 631:2-b.
(k) “Granite advantage health care program
(granite advantage)” means the granite advantage health care program
established under RSA 126-AA which provides medicaid coverage
to adults eligible under Title XIX of the Social Security Act 1902(a)(10)(A)(i)(VIII).
(l)
“Good cause” means circumstances that
prevented the beneficiary from meeting the community engagement requirement
pursuant to He-W 837.10.
(m)
“Homeless” means a situation in which an individual lacks a fixed, regular, and
adequate nighttime residence such as living in a publicly or privately operated
shelter, or living in a public or private location not meant for human
habitation, and includes a situation in which an individual is in peril of
losing his or her primary residence, no subsequent residence has been
identified, and the individual lacks support networks to obtain permanent
housing.
(n) “Immediate family member” means a spouse,
child(ren), mother-in-law, father-in-law, parent(s), step-parent(s),
step-child(ren), step-brother(s), step-sister(s), grandparent(s),
grandchild(ren), brother(s), sister(s), legal guardian(s), daughter(s)-in-law,
son(s)-in-law, brother(s)-in-law, sister(s)-in-law, and foster child(ren).
(o)
“Licensed medical professional” means a physician, an advanced practice registered
nurse (APRN), a behavioral health professional who is able to determine
eligibility for community mental health services pursuant to He-M 401.04, a
physician assistant, a licensed alcohol and drug counselor (LADC), a master of
licensed alcohol and drug counselor (MLADC), nurse case manager, or a
board-certified psychologist.
(p) “Medicaid” means the Title XIX program
administered by the department, which makes medical assistance available to
eligible individuals.
(q) “Medically frail” means a beneficiary, as
defined in 42 CFR 440.315(f), with a disabling mental disorder, chronic
substance use disorder (SUD), serious and complex medical condition, or a
physical, intellectual, or developmental disability that significantly impairs
the ability to perform one or more activities of daily living as certified by a
licensed medical professional.
(r) “Noncompliant” means a status where a
beneficiary failed to meet the 100 hour per calendar month community engagement
requirement in a single month.
(s) “Redetermination” means the annual medicaid eligibility renewal process required by 42 CFR
435.916, He-W 606, and He-W 684.
(t) “Stalking” means engaging in a course of
conduct directed at a specific person that would cause a reasonable person to
fear for the person’s individual safety or the safety of others or suffer
substantial emotional distress.
(u) “Sexual assault” means sexual assault as defined
in RSA 632-A:4.
(v) “Voluntary” means a community engagement
status in which a beneficiary is not required to participate in the community
engagement requirement but chooses to do so.
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19
He-W 837.02 Community
Engagement Requirement.
(a) Unless exempted
under He-W 837.03 below or able to demonstrate good cause under He-W 837.10, beneficiaries
shall engage in 100 hours per calendar month in one or more of the community
engagement activities listed in He-W 837.05 below.
(b) A beneficiary
shall have until the first full month following 75 calendar days from the date
of the eligibility determination or the expiration of an exemption to come into
compliance with the community engagement requirement.
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.03)
He-W 837.03 Exemptions.
(a)
Beneficiaries meeting at least one of the following conditions shall be
exempted from the community engagement requirement:
(1) Beneficiaries who are unable to participate
due to illness, incapacity, or treatment, as certified by a licensed medical professional. This exemption shall include the
beneficiary’s participation in inpatient and residential outpatient SUD
treatment or intensive outpatient SUD services that is consistent with Levels
2.1 and above as found in the American Society of Addiction Medicine (ASAM)
Criteria: Treatment Criteria for
Substance-Related, Addictive, and Co-Occurring Conditions, Third Edition (2013),
henceforth referred to as “ASAM Criteria 2013”, available as noted in Appendix
A;
(2) Beneficiaries who are participating in a
state-certified drug court program;
(3) A custodial parent or caretaker as defined in
RSA 167:82, II(g) where the required care is considered necessary by a licensed
medical professional;
(4) A custodial parent or caretaker of a
dependent child under 6 years of age provided that the exemption shall only apply to one parent or caretaker of
a common child or children in the case of a 2-parent household;
(5) A custodial parent or caretaker of a child
with developmental disabilities who is residing with the parent or caretaker;
(6) Pregnant women as defined in 42 CFR 435.4;
(7) Beneficiaries with a disability who are
unable to comply with the community engagement requirement due to
disability-related reasons;
(8) Beneficiaries residing with an immediate
family member who has a disability and is unable to meet the community engagement
requirement for reasons related to the family member’s disability;
(9) Beneficiaries who experience a
hospitalization or serious illness;
(10) Beneficiaries residing with an immediate
family member who experiences a hospitalization or serious illness; or
(11) Beneficiaries who are medically frail, as
certified by a licensed medical professional.
(b)
Beneficiaries meeting at least one of the conditions in (a)(1) – (11)
above shall complete the required form for the condition as specified for the
condition in accordance with He-W 837.04 below.
(c) Beneficiaries
who fall in at least one of the following categories, based on the information
available in the department’s eligibility system(s), shall be exempted from the
community engagement requirement and shall not have to supply additional
information to the department:
(1) Beneficiaries who are approved by the
department for aid to the permanently and totally disabled (APTD), aid to the
needy blind (ANB), medicaid for employed adults with
disabilities (MEAD), nursing facility, home and community based services
(HCBS), or home care for children with severe disabilities through age 20
(HC-CSD);
(2) Beneficiaries who are receiving supplemental
security income (SSI), social security disability income (SSDI), railroad
disability, or veteran disability benefits;
(3) Beneficiaries who are pregnant as defined in
42 CFR 435.4, and whose pregnancy status is indicated in the department’s
eligibility system(s);
(4) A beneficiary who is a custodial parent or
caretaker for a dependent child under 6 provided that the exemption shall only
apply to one parent or caretaker of a common child or children in the case of a
2-parent household;
(5) A beneficiary who is a custodial parent or
caretaker of a child with developmental disabilities who is residing with the
parent or caretaker and who is currently approved by the department for
services under the home and community based services developmental disability
waiver (HCBS-DD);
(6) Beneficiaries who are receiving supplemental
nutritional assistance program (SNAP) benefits and who are exempt from the program’s
employment requirements;
(7) Beneficiaries who are receiving temporary
assistance for needy families (TANF) benefits and who are exempt from the
program’s employment requirements; and
(8) Beneficiaries who are enrolled in health insurance
premium program (HIPP).
(d)
The exemptions in (c) above shall continue for as long as the particular
circumstance continues to exist.
(e)
A beneficiary who is exempted in (c) above may request to participate
voluntarily in the community engagement requirement and shall have access to
the granite workforce program pursuant to He-W 639.
(f)
Beneficiaries voluntarily participating in the community engagement
requirement in (e) above shall not be subject to suspension or termination for
noncompliance with the community engagement requirement.
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.04)
He-W 837.04 Request for Exemption; Duration of
Exemptions.
(a)
All beneficiaries requesting an exemption shall complete and submit BFA
Form 330 “Exemption Request Form Granite Advantage Health Care Program” (06/19).
(b)
Beneficiaries requiring certification by a licensed medical professional
in (c) below shall have a licensed medical professional certify on BFA Form
330 to the following:
“As
a licensed medical professional caring for this beneficiary, I hereby certify
(based on the description of the exemptions provided in the instructions to
this form) that the beneficiary meets the qualifications for the exemption(s)
requested in Section II.”
(c)
Beneficiaries shall provide the following third party certification or
documentation to the department for the indicated exemption types:
(1) For beneficiaries unable to participate due
to illness, incapacity, or treatment under He-W 837.03(a)(1) above, provide a
certification by a licensed medical professional specifying the duration and
limitations of the illness, incapacity, or treatment. The duration of the exemption shall be one
month or the date range specified by the licensed medical professional,
whichever is longer;
(2) For beneficiaries participating in a state
certified drug court program under He-W 837.03(a)(2) above, provide a copy of
the legal documentation requiring the beneficiary to participate in the drug
court program. The duration of this
exemption shall be one year from the date that the required documentation is
received;
(3) For a parent or caretaker under He-W
837.03(a)(3) above, provide a certification by a licensed medical professional
that specifies the duration that such care is required. Unless specified otherwise by the licensed
medical professional, the duration of this exemption shall be one year from the
date that the required documentation is received;
(4)
For a parent or caretaker of a dependent
child under 6 years of age under He-W 837.03(a)(4) above, provide a
self-attestation and the child’s date of birth;
(5) For a custodial parent or caretaker of a
child with developmental disabilities under He-W 837.03(a)(5) above, provide a
certification by a licensed medical professional of the child’s developmental
disability. The duration of this
exemption shall be for as long as the particular circumstance continues to
exist;
(6) For beneficiaries with a disability under He-W
837.03(a)(7) above, provide an annual certification by a licensed medical
professional of the beneficiary’s inability to meet the community engagement requirement
for reasons related to the disability. The
duration of this exemption shall be one year from the date that the required
documentation is received or the date range specified by the licensed medical
professional, whichever is less;
(7) For beneficiaries residing with an immediate
family member with a disability under He-W 837.03(a)(8) above, provide an
annual attestation of the beneficiary’s inability to meet the community
engagement requirement for reasons related to the family member’s disability
and an annual certification by the family member’s licensed medical
professional specifying the family member’s disability. The duration of this exemption shall be one
year from the date that the required documentation is received or the date
range specified by the licensed medical professional, whichever is less;
(8) For beneficiaries unable to participate due
to hospitalization or serious illness under He-W 837.03(a)(9) above, provide
copies of discharge summaries, or financial or billing information, documenting
the hospitalization or serious illness or dates of stay. The duration of this exemption shall be one
month or the date range specified by the licensed medical professional,
whichever is longer;
(9) For beneficiaries who are unable to participate
due to hospitalization or serious illness of an immediate family member under
He-W 837.03(a)(10) above, provide copies of the family member’s discharge summaries,
or financial or billing information, documenting the hospitalization or serious
illness. The duration of this exemption
shall be one month or the date range specified by the licensed medical
professional, whichever is longer; and
(10) For medically frail beneficiaries under He-W
837.03(a)(11) above, an annual completion and submission of a. and b.
below:
a. BFA Form 320A “Beneficiary Authorization for
Licensed Medical Professional to Release Protected Health Information - Granite
Advantage Health Care Program” (05/19) permitting and authorizing disclosure of
protection health information as follows:
“I
hereby authorize the following licensed medical professional to disclose my protected
health information for the purposes described above.”
“In
addition, I hereby authorize the following specific disclosures (place your
initials on the line by those statements which apply)
I
specifically authorize the release of my mental health treatment records.
I
specifically authorize the release of my HIV and AIDS results and/or treatment.
I
specifically authorize the release of my alcohol and/or drug abuse treatment
records in accordance with 42 CFR Part 2.”
“I
give authorization for my protected health information to be released to the
following individual or organization:
Name: Granite Advantage Health Care Program Manager
Organization: Department of Health and Human Services
Address: DHHS, Granite Advantage Health Care Program,
P.O. Box 3778, Concord, NH 03302-3778 or Fax # 603-271-5623
I
understand this authorization may be revoked by notifying the Department of
Health and Human Services in writing to the address above”; and
b. BFA Form 331 “Licensed Medical Professional
Certification of Medical Frailty Granite Advantage Health Care Program” (05/19)
indicating that the beneficiary is unable to comply with the work and community
engagement requirement as a result of their condition including the duration of
such disability. The duration of this
exemption shall be one year from the date that the required certification is
received or the date range specified by the licensed medical professional,
whichever is less. The licensed medical
professional shall certify as follows:
“As
a licensed medical professional caring for this beneficiary, I hereby certify
that the beneficiary is medically frail based on the beneficiary having one or
more of the conditions identified above.”
(d)
To the extent practicable, third party certification or documentation
shall be submitted to the department with the form required in (a) above.
(e) A request for an exemption under this section
shall not be considered complete until all of the required documentation is
received by the department.
(f) For pregnant women, the beneficiary may
report pregnancy by completing and submitting BFA Form 330 or by informing the
department.
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.05); BFA form 330 in (a) amd by #12828
He-W
837.05 Qualifying Activities. The following activities shall qualify as
activities for the community engagement requirement:
(a) Unsubsidized employment including by
non-profit organizations;
(b) Subsidized private sector employment;
(c) Subsidized public sector employment;
(d) On-the-job training;
(e) Job skills training related to employment;
(f) Enrollment at an accredited community
college, college, or university that is counted on a credit hour basis;
(g) Job search and job readiness assistance, including
but not limited, to participation in job search or job training activities
offered through the department of employment security or through other job
search or job readiness assistance programs such as the Workforce Innovation
and Opportunity Act (WIOA) or work ready New Hampshire. Time spent in any assessment, training,
enrollment, or case management activity that is necessary for participation in
a job search or job readiness program shall be credited
as job search and job readiness assistance hours;
(h) Vocational
educational training not to exceed 12 months with respect to any beneficiary;
(i) Education
directly related to employment, in the case of a beneficiary who has not
received a high school diploma or certificate of high school equivalency;
(j) Attendance at secondary school or in a course
of study leading to a certificate of general equivalence, in the case of a
beneficiary who has not completed secondary school or received such a certificate;
(k) Community, volunteer, or public service except
that community, volunteer, or public service under this part shall not include
services provided to or on behalf of a political organization or campaign;
(l) Caregiving services for a non-dependent
relative or other person with a disabling medical, mental health, or
developmental condition;
(m) Participation in ASAM Level 1 outpatient SUD
services, including medication assisted treatment, and recovery supports, as
set forth in ASAM Criteria (2013);
(n) Participation in and compliance with SNAP
employment requirements;
(o) Participation in and compliance with the TANF
employment requirements;
(p) Participation in and compliance with the
employment requirements of the refugee resettlement program pursuant to 45 CFR
400.75; or
(q) Self-employment.
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.06)
He-W
837.06 Reporting of Community
Engagement Activities and Crediting of Hours.
(a) The following types of community engagement
activities shall be reported by completing and submitting BFA Form 321
“Reporting Education Participation for Community Engagement – Granite Advantage
Health Care Program” (06/19):
(1) For job skills training related to employment
under He-W 837.05(e), the beneficiary shall provide documentation of enrollment
that includes the duration and the number of hours per month the beneficiary is
participating in the activity;
(2) For enrollment at an accredited community
college under He-W 837.05(f), the beneficiary shall provide documentation of enrollment
that includes a copy of the beneficiary’s class schedule, the number of credit
hours assigned for the enrolled class(es), and the semester begin and end date. The number of community engagement hours to
be credited shall be determined by multiplying the number of credit hours
assigned for the enrolled class(es) by 4.33;
(3) For vocational educational training under
He-W 837.05(h), the beneficiary shall provide documentation of enrollment that
includes the duration of the activity and a copy of the beneficiary’s
enrollment in the program. Community
engagement hours shall be credited at 100 hours per month for the duration of
the beneficiary’s verified participation in the activity not to exceed 12
months;
(4) For education directly related to employment
under He-W 837.05(i), the beneficiary shall provide
documentation of enrollment that includes the duration of the activity. Community engagement hours shall be credited
at 100 hours per month for the duration of the beneficiary’s verified participation
in the activity; and
(5) For study leading to a certificate of general
equivalence under He-W 837.05(j), the beneficiary shall provide documentation
of enrollment that includes the duration of the activity. Community engagement hours shall be credited
at 100 hours per month for the duration of the beneficiary’s verified participation
in the activity;
(b) The types of community engagement activities
listed in (c) below shall be reported on a completed and submitted BFA Form 320
“Reporting Monthly Participation in Community Engagement Activities - Granite Advantage Health Care Program” (06/19).
(c) Beneficiaries shall provide the requested
information on the form in (b) above, and the hours reported on the form in (b)
above shall be credited toward the community engagement requirement as follows:
(1) For time spent participating in job search
and job readiness efforts under He-W 837.05(g), the beneficiary shall report
the type, duration of the activity, and total number of hours per month;
(2) For community, volunteer, or public service
under He-W 837.05(k), the beneficiary shall report where and when the
community, volunteer, or public service was performed, the number of hours
performed, and the contact information for the organization or individual the
service was performed for;
(3) For caregiving services under He-W 837.05(l),
the beneficiary shall report the name and contact information for the non-dependent
relative or other person cared for, a description of the services provided, and
the number of hours of caregiving services provided;
(4) For participation in ASAM Level 1, as set
forth in ASAM Criteria (2013), outpatient SUD services under He-W 837.05(m),
the beneficiary shall report the name of the agency or organization the services
were received from, and the number of hours that the beneficiary participated
in the services up to 40 hours per month.
For participation in any other ASAM level treatment, see exemption He-W
837.03(a)(1);
(5) For beneficiaries experiencing a temporary
increase in monthly employment hours for seasonal work or for other such work
greater than the beneficiary’s average monthly employment hours as credited
pursuant to (d)(4) below, the beneficiary shall report the increased hours
which shall be limited to 2 consecutive months; and
(6) For beneficiaries who are self-employed and
work more hours than calculated by the department’s eligibility system(s), the
beneficiary shall report the additional hours worked, and a description of the
hours work and tasks performed.
(d) The indicated community engagement activities
below shall be credited as follows if the activity is verified by the
department’s eligibility system(s):
(1) For system-verified participation in and compliance
with SNAP employment requirements, community engagement hours shall be credited
at 100 hours per month for the duration of the beneficiary’s verified
participation in the program;
(2) For system-verified participation in and
compliance with TANF employment requirements, community engagement hours shall
be credited at 100 hours per month for the duration of the beneficiary’s
verified participation in the program;
(3) For participation in and compliance with the
employment requirements of the refugee resettlement program pursuant to 45 CFR
400.75, systemic verification of legal status and enrollment in the program. and community engagement hours shall be
credited at 100 hours per month for 12 months from the date of the
beneficiary’s entry into the United States; and
(4) Employment information gathered during the
application or redetermination process or in the department’s eligibility
system(s) shall be used to determine a beneficiary’s average monthly employment
hours and shall be credited towards the community engagement requirement for
employment activities listed in He-W 837.05(a)-(d).
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.07); BFA form 321 in (a) and BFA form 320 in (b) amd
by #12828
He-W 837.07 Beneficiaries with Disabilities: Reasonable Modification.
(a) A beneficiary with a disability shall be
entitled to reasonable modifications related to meeting the community engagement
requirement.
(b) Reasonable modifications shall include:
(1) Modification in the number of community engagement
hours required where the beneficiary is unable to participate in the required
number of hours; or
(2) Assistance with understanding granite
advantage to include, but not be limited to, departmental notices, eligibility
requirements, exemption requirements, how to apply for an exemption, program
benefits, how to establish eligibility, and how to meet and report community
engagement activities to maintain eligibility.
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.08)
He-W 837.08 Opportunity to Cure.
(a) If a beneficiary fails to meet the required
community engagement hours, the beneficiary shall satisfy the community
engagement requirement by making up the deficit hours for the noncompliant
month by doing one of the following:
(1) Curing the deficit hours by engaging in the
activities listed in He-W 837.05 above in the following month for only the
number of deficit hours for the noncompliant month. For example:
a. A beneficiary engaged in 60 hours of
community engagement activities in January, resulting in a 40-hour
deficit. The beneficiary worked 100
hours in February. The beneficiary’s
noncompliance for January shall be cured, and the beneficiary shall be
considered compliant with February; or
b. A beneficiary engaged in 60 hours of community
engagement activities in January, resulting in a 40-hour deficit. The beneficiary shall only need to complete
40 hours of community engagement activities in February to cure January’s deficit. The beneficiary worked 60 hours in
February. The beneficiary shall be
considered compliant for January, and shall be considered noncompliant for
February with a 40-hour deficit;
(2) Demonstrating good cause for the failure to
meet the community engagement requirement as described in He-W 837.10; or
(3) Providing documentation of an exemption
pursuant to He-W 837.04.
(b) Within 10 days following the noncompliant
month, the department shall provide written notice to the beneficiary of
failure to meet the community engagement requirement to include:
(1) How a beneficiary can cure the noncompliance
as described in (a) above; and
(2) Information regarding potential suspension
pursuant to He-W 837.9 below.
(c) At no time shall a beneficiary be required to
work more than 100 hours in a single month.
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.09)
He-W 837.09 Suspension.
(a) If a beneficiary does not cure the deficit
hours as described in He-W 837.08(a), the department shall suspend the
beneficiary’s eligibility effective the first of the month following the
one-month opportunity to cure, subject to appeal pursuant to He-W 837.17.
(b) Prior to suspension, the department shall
provide, at a minimum, a ten-day written notice to the beneficiary that his or
her medicaid eligibility shall be suspended due to
noncompliance, and shall include all applicable notice requirements found in 42
CFR 431, Subpart E, and appeal rights pursuant to He-W 837.17.
(c) The suspension shall
remain in effect until the beneficiary reactivates eligibility prior to
redetermination by:
(1) Satisfying within a single
calendar month the deficit hours from the noncompliant month or by satisfying
within a single calendar month the deficit hours from the cure month, whichever
is less;
(2) Demonstrating within a single
calendar month enough good cause hours pursuant to He-W 837.10 and He-W 837.11
to fully cover the number of deficit hours;
(3) Demonstrating within a single calendar month
a combination of community engagement hours and good cause hours sufficient to
fully cover the number of deficit hours;
(4) Providing documentation of an
exemption pursuant to He-W 837.04; or
(5) Becoming eligible for medicaid
under an eligibility category that is not subject to the community engagement
requirement.
(d) Reactivation shall be
effective:
(1) On the date that the deficit hours are
reported to the department;
(2) On the date the department receives the required
attestation or third party certification or documentation to establish good
cause or an exemption; or
(3) On the date that the beneficiary was admitted
to the hospital where the beneficiary was found to have good cause pursuant to
He-W 837.10(a)(8) or an exemption under He-W 837.03, and has good cause or an
exemption within 30 calendar days of the date of their hospital discharge.
(e) Upon reactivation in (d) above, a
beneficiary’s obligation to meet the community engagement requirement shall begin
on the first full month following the month in which the beneficiary’s
eligibility is reactivated.
(f) After suspension, a beneficiary shall not be
required to complete a new medicaid application if
she or he has met one of the requirements of (c) above.
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.10)
He-W
837.10 Good Cause.
(a) Good cause shall include, but not be limited
to, the following circumstances:
(1) The beneficiary experiences the birth or
death of a family member residing with the beneficiary;
(2) The beneficiary experiences severe inclement
weather, including a natural disaster, and was unable to meet the requirement;
(3) The beneficiary has a family emergency or
other life-changing event such as divorce;
(4) The beneficiary is a victim of domestic
violence, dating violence, sexual assault or stalking;
(5) The beneficiary is a custodial parent or
caretaker of a child 6 to 12 years of age who, as determined by the commissioner
on a monthly basis, is unable to secure child care in order to participate in
community engagement activities either due to a lack of child care scholarship
or the inability to obtain a child care provider due to capacity, distance, or
another related factor;
(6)
The beneficiary has a disability, and was unable to meet the community
engagement requirement for reasons related to that disability;
(7) The beneficiary resides with an immediate
family member who has a disability, and was unable to meet the community
engagement requirement for reasons related to the family member’s disability,
but did not request an exemption from the community engagement requirement;
(8) The beneficiary experienced a
hospitalization, but did not request an exemption from the community engagement
requirement;
(9) The beneficiary resides with an immediate
family member who experienced a hospitalization or serious illness, but the beneficiary
did not request an exemption from the community engagement requirement;
(10)
The beneficiary is homeless; or
(11) Other good cause exists, such as
circumstances beyond the beneficiary’s control which related to the beneficiary’s
ability to obtain or retain a qualifying community engagement activity. Other good cause shall include an illness
that did not require inpatient hospitalization.
(b) All beneficiaries requesting a finding of
good cause shall complete and submit BFA Form 340 “Good Cause Request Form -
Granite Advantage Health Care Program” (04/19) along with any required third
party certification(s) to the department.
(c) Beneficiaries requiring certification by
licensed medical professional for good cause in (d) below shall have the
licensed medical professional certify on BFA Form 340 “Good Cause Request Form. Granite Advantage Health Care Program” (06/19)
as follows:
“A
showing of good cause for “disability” or “Caretaker residing with immediate
family member with disability” requires certification by a licensed medical
professional. As a licensed medical
professional caring for this beneficiary or for a beneficiary’s family member
with a disability, I hereby certify that:
The beneficiary is disabled and unable to meet the community engagement
requirement for reasons related to their disability; or the family member identified
above is disabled.”
(d) A beneficiary’s request for a finding of good
cause shall be attested to and certified as follows:
(1)
For a beneficiary who experiences the
birth or death of a family member residing with the beneficiary, attestation by
the beneficiary of the event to include the name of the family member, the date
of the event, the family member’s relationship to the beneficiary, and the number
of days impacted;
(2) For a beneficiary who experiences severe
inclement weather, including a natural disaster, and therefore was unable to
meet the requirement, attestation by the beneficiary of the date(s) of the
severe inclement weather or natural disaster, and the number of days impacted;
(3) For a beneficiary who has a family emergency or
other life-changing event such as divorce, attestation by the beneficiary of
the nature of the family emergency or life-changing event to include the
date(s) and the number of days that the beneficiary was unable to participate
due to the circumstance;
(4) For a beneficiary who is a victim of domestic
violence, dating violence, sexual assault, or stalking, documentation of the
date range specified in the court order or self-attestation to the number of
days impacted;
(5) For custodial parents as described in (a)(5)
above, a monthly attestation by the beneficiary of the inability to secure
child care and the number of days impacted;
(6)
For a beneficiary who has a disability,
, and was unable to meet the requirement for reasons related to that disability
the following shall be required:
a. Attestation by the beneficiary of the number
of days the beneficiary was unable to meet the community engagement requirement
for reasons related to the disability; and
b. The certification described in (c) above;
(7) For a beneficiary who resides with an immediate
family member who has a disability, and was unable to meet the requirement for
reasons related to the family member’s disability, but did not request an
exemption from the community engagement requirement, the following shall be
required:
a. Attestation by the beneficiary of the number
of days the beneficiary was unable to meet the community engagement requirement
for reasons related to that disability; and
b. The certification described in (c) above;
(8) For a beneficiary who experienced a hospitalization,
but did not request an exemption from community engagement requirement, the
following shall be required:
a. Attestation by the beneficiary of the number of
days of the hospitalization and the admission date; and
b. Copies of the discharge summaries, or
financial or billing information that would substantiate the hospitalization or
certification by a licensed medical professional;
(9) For a beneficiary who resides with an
immediate family member who experienced a hospitalization or serious illness,
but the beneficiary did not request an exemption from community engagement requirement,
the following shall be required:
a. Attestation by the beneficiary of the number
of days of the hospitalization or serious illness or certification by a licensed
medical professional; and
b. Copies of the family member’s discharge
summary, or financial or billing information, or other medical records that
would substantiate the hospitalization or serious illness;
(10) For a beneficiary who is homeless, attestation
by the beneficiary of the beneficiary’s homelessness or inability to find stable
housing and the number of days the beneficiary was unable to meet the community
engagement requirement; or
(11) For a beneficiary to claim other good cause
under (a)(11), attestation by the beneficiary of the circumstance beyond the
beneficiary’s control which relate to the beneficiary’s ability to obtain or
retain a community engagement activity to participate in, and the number of
days the beneficiary was unable to meet the community engagement requirement.
(e) A request for a finding of good cause under
this section shall not be approved unless the required attestation(s) and
certification(s) are received by the department.
(f) The department shall use the documentation
received to determine if the community engagement requirement would have been
met if not for the good cause.
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.11); BFA form 340 in (c) amd by #12828
He-W
837.11 Crediting a Finding of Good
Cause.
(a) A finding of good cause shall be credited
toward the monthly community engagement requirement as follows:
(1) For a beneficiary who experiences the birth
or death of a family member residing with the beneficiary, 8 hours per day for
each day the beneficiary attested being unable to participate;
(2) For a beneficiary who experiences severe
inclement weather including a natural disaster, 8 hours per day for each day the
beneficiary attested being unable to participate;
(3) For a beneficiary who has a family emergency
or other life changing event such as divorce, 8 hours per day for each day the
beneficiary attested being unable to participate;
(4) For a beneficiary who is a victim of domestic
violence, dating violence, sexual assault, or stalking, 8 hours per day for each
day the beneficiary attested being unable to participate or the date range
specified in the court order;
(5) For a beneficiary who is a custodial parent
or caretaker of a child 6 to 12 years of age who is unable to secure child care
in order to participate in community engagement, 8 hours per day for each day
the beneficiary attested being unable to participate;
(6) For a beneficiary with a disability who was
unable to meet the requirement for reasons related to that disability, 8 hours
per day for each day the beneficiary was unable to participate, or, if no date
range is indicated, 100 hours per month for each month the beneficiary was
unable to participate;
(7) For a beneficiary residing with an immediate
family member who has a disability, and was unable to meet the requirement for
reasons related to the family member’s disability, 8 hours a day for each day
the beneficiary was unable to participate, or, if no date range is indicated,
100 hours per month for each month the beneficiary was unable to participate;
(8) For a beneficiary who experiences a
hospitalization, but did not request an exemption the following shall apply:
a. For inpatient hospitalization, 100 hours per
month for each month the beneficiary was unable to participate; or
b. For outpatient hospitalization, 8 hours per
day for each day the beneficiary was unable to participate as documented
through self-attestation or a certification by a licensed medical professional;
(9) For a beneficiary who resides with an
immediate family member who experienced a hospitalization or serious illness,
but the beneficiary did not request an exemption the following shall apply:
a. For inpatient hospitalization, 8 hours per
day for each day the beneficiary attested being unable to participate; or
b. For outpatient hospitalization or serious
illness, 8 hours per day for each day the beneficiary was unable to participate
as documented through self-attestation or a certification by a licensed medical
professional;
(10) For a beneficiary who is homeless or unable
to find stable housing, 8 hours per day for each day the beneficiary attested
being unable to participate; and
(11) For other good cause, 8 hours per day for
each day the beneficiary attested being unable to participate.
(b) If the beneficiary’s good cause did not fully
cover the number of deficit hours in that month, the beneficiary shall be
determined noncompliant for the month, resulting in the beneficiary’s
responsibility to cure as required in He-W 837.08(a).
Source. #12733, INTERIM,
eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.12)
He-W
837.12 Limitation on the Repeated
Consecutive Use of Curing to Meet the Community Engagement Requirement.
(a) Beginning May 1, 2020, a beneficiary, who
engages in the repeated consecutive use of cure for 12 months immediately prior
to redetermination, shall be suspended at redetermination.
(b) Following suspension in (a) above, a
beneficiary may reactivate eligibility under this section by providing 100
hours of community engagement within a single calendar month.
(c) Reactivation shall be effective on the date
the 100 community engagement hours are reported to the department.
(d) After reactivation in (c) above, a
beneficiary’s participation start date shall be the 1st of the month following
the month in which the beneficiary’s eligibility is reactivated.
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.13)
He-W
837.13 Extra Hours. A beneficiary shall not be permitted to
carry-over hours in excess of the 100-hour requirement in order to satisfy the
community engagement requirement.
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.14)
He-W
837.14 Disenrollment and Reconsideration.
(a) A beneficiary who is suspended for
noncompliance with the community engagement requirement, and fails to cure that
suspension during redetermination, shall be disenrolled from granite advantage.
(b) A disenrolled beneficiary shall be re-enrolled
as follows:
(1) Within 90 days of disenrollment, a beneficiary
may return to granite advantage by providing 100 hours of community engagement
within a single calendar month;
(2) Upon the department’s receipt of the reported
100 hours in (b)(1) above, the beneficiary’s eligibility shall be reopened as
of the date that the hours are reported to the department; and
(3)
The beneficiary’s participation start
date shall be the 1st of the month following the report in (b)(2) above.
(c) A beneficiary who is compliant with the
community engagement requirement at redetermination but whose eligibility is
terminated at redetermination for other reasons may, within 90 days of
disenrollment, return to granite advantage by:
(1) Satisfying any outstanding medicaid redetermination requirements pursuant to 42 CFR
435.119, 42 CFR 435.916, He-W 606, and He-W 684;
(2)
Upon satisfying any outstanding redetermination requirements in (c)(1) above,
the beneficiary’s eligibility shall be reactivated to the date of closure; and
(3) The beneficiary shall resume the reporting of
community engagement hours the 1st of the month following the month that the
outstanding redetermination requirements are met.
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.15)
He-W
837.15 Re-Application.
(a) A beneficiary may reapply for medicaid at any time after disenrollment.
(b) If a beneficiary reapplies, the following
shall apply:
(1) A beneficiary who was disenrolled at redetermination
and who reapplies within 6 months and is determined eligible, shall begin to
report community engagement hours on the 1st of the month following the month
in which the application is filed;
(2) A beneficiary, who was disenrolled at
redetermination and who reapplies 6 or more months thereafter and is determined
eligible, shall in accordance with He-W 837.02 have until the first full month
following 75 calendar days from the date of their eligibility determination
before he or she is required to meet the 100-hour community engagement
requirement; and
(3)
For purposes of this section, the
6-month period shall be calculated using 365/2 rounded down equaling 182 days.
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.16)
He-W
837.16 Screening for Other Bases of
Medicaid Eligibility Prior to Suspension, Termination, Disenrollment, or Denial
of Eligibility. Suspension,
termination, disenrollment, or denial of eligibility shall only occur after a
beneficiary is screened and determined to be ineligible for all other bases of medicaid eligibility and reviewed for eligibility for
insurance affordability programs in accordance with 42 CFR 435.916(f).
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.17)
He-W
837.17 Appeals.
(a) A beneficiary may appeal the department’s
decision denying an exemption under He-W 837.04, denying a request for good
cause under He-W 837.10, denying a reasonable modification under He-W 837.07,
or suspending, denying, or terminating the beneficiary’s eligibility for
failing to meet the community engagement requirement under He-W 837.02 by
filing a request for an appeal with the department’s administrative appeals
unit in accordance with He-C 200.
(b) The department shall not suspend, deny, or
terminate the beneficiary’s eligibility under (a) above if the beneficiary:
(1) Submits a hearing request to the local
district office within 30 days from the date on the written notice of adverse
decision; and
(2) Submits a request to the local district
office for a continuation of benefits during the appeal process within 15 days
of the date on the written notice of adverse decision.
Source. #12733, INTERIM,
eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.18)
He-W
837.18 Other Department Obligations.
(a) The department shall periodically assess
compliance with the community engagement requirement in labor market areas, within
the state, to assess whether mitigation strategies are needed so that the
community engagement requirement is not unreasonably burdensome.
(b) The department shall examine the following:
(1) Areas that experience high rates of
unemployment;
(2) Areas with limited economies and educational
opportunities; and
(3) Areas with a lack of public transportation.
(c) The department shall provide information and assistance
to beneficiaries, including oral and written explanations, regarding community engagement
activities, exemptions from participation in the community engagement requirement,
good cause exemptions, appeal rights, suspension, disenrollment, and termination,
and the opportunity to cure to facilitate beneficiaries’ compliance with the
program’s community engagement requirement, and any other information related
to the community engagement requirement and this part.
(d) The department shall develop an eligibility
and enrollment monitoring plan that includes metrics, timetables, and programmatic
content to ensure processes are in place.
(e) The plan shall include the collection and
analysis of data for the following data points:
(1) The number and percentage of beneficiaries
who have requested exemption from the community engagement requirement;
(2) The number and percentage of beneficiaries
who have been granted an exemption from the community engagement requirement;
(3) The number and percentage of community
engagement good cause requested;
(4) The number and percentage of beneficiaries
granted good cause from the community engagement requirement;
(5) The number and percentage of beneficiaries
whose eligibility was terminated at redetermination for not meeting the
community engagement requirement;
(6) The number and percentage of community
engagement appeal requests; and
(7) The number and percentage of beneficiaries
whose eligibility was suspended for failing to comply with the community
engagement requirement.
Source. #12733,
INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W
837.19)
PART He-W 841
He-W 841.03 Medicaid
for Employed Adults with Disabilities (MEAD).
(a) In accordance
with RSA 167:3-i, RSA 167:3-c, XII, RSA 167:6, IX, and 42 USC 1396a(a)(10)(A)(ii)(XV)
relative to medical assistance for employed adults with disabilities, medical
assistance shall be provided to any applicant who:
(1) Meets
the general and technical requirements for aid to the permanently and
totally disabled (APTD) or aid to the needy blind (ANB) as specified in He-W 600
and He-W 800;
(2) Is age
18 through 64, inclusive;
(3) Meets
the medical criteria for MEAD pursuant to He-W 504.02;
(4) Is employed
for pay pursuant to He-W 841.03(b), or self-employed for pay pursuant to He-W 841.03(c),
on the date of application, during the time of MEAD eligibility determination,
and during the retroactive period, should the individual request this medical
coverage period;
(5) Has net
income determined by applying the APTD or ANB treatment and disregards to his or
her gross income, and if applicable, to the spouse’s gross income pursuant
to He-W 654 and He-W 854, that when combined with spousal net income does not
exceed 450% of the federal poverty guidelines, as published annually in the federal
register and effective no later than the first of the month following the first
complete month after the federal poverty income guidelines have been published
in the federal register;
(6) Has
countable resources that do not exceed the 2002 limit of $20,000 for an individual
or $30,000 for a married couple, the amounts of which shall be updated annually
in accordance with (a)(5) above by the percentage that applies pursuant to the
Consumer Price Index; and
(7) Pays the monthly
premium, established pursuant to He-C 5003.
(b) To
be considered employed for pay, an individual shall:
(1) Receive remuneration
and contribute to the Federal Insurance Contributions Act (FICA); and
(2) Not be paid for
participation in a program designed to enhance an individual’s ability to obtain
paid employment.
(c) To be considered self-employed
for pay, an individual shall:
(1) Meet the
requirements of (b)(2) above; and
(2) Provide
documentation that he or she makes regular payments based on earnings
as required pursuant to the Self-Employment Contributions Act (SECA).
(d) The items listed below shall not
be counted as a resource when determining MEAD eligibility:
(1) Retirement plans;
(2) Medical savings
accounts established pursuant to 26 USC 220; and
(3) MEAD employability
accounts specifically designated and set aside by the individual for the purpose
of purchasing certain goods or services that:
a. Will
enhance an applicant’s employability; and
b. Are not:
1. Covered by
the Medicaid program;
2. Otherwise
reimbursable;
3. Specifically
excluded pursuant to He-W 856; or
4. Already
allowed as a deduction pursuant to He-W 654 or He-W 854.
(e) Goods
or services for which MEAD employability accounts may be designated
and set aside pursuant to (d)(3) above shall include, but not be limited to:
(1) Equipment,
supplies, operating capital, and inventory required to establish a business;
(2) Any cost associated
with an educational or occupational training facility, including, but not
limited to, tutoring, or counseling;
(3) Work-related
attendant care services to enable the individual to prepare for work,
including, but not limited to, bathing and dressing, or services provided in the
workplace;
(4) Medical devices,
which enable the applicant to work, including, but not limited to:
a. Wheelchairs;
b. Prosthetics;
c. Pacemakers;
and
d. Respirators;
(5) Equipment or
tools either specific to an applicant's condition or designed for general use;
(6) Uniforms,
specialized clothing, and safety equipment;
(7) Least
costly transportation cost(s) to and from work, such as weekly or monthly bus
passes;
(8) Purchase of
a private vehicle;
(9) Operational or
accessibility modifications to buildings or vehicles to accommodate disability;
(10) Routine drugs
or medical services to ameliorate disability that are not covered by Medicaid;
(11) Diagnostic procedures
related to evaluation, control, or treatment of a disabling condition;
(12) Prescribed non-medical
appliances and devices essential for controlling the disabling condition at
home or work such as air filtering equipment;
(13) Expendable medical
supplies; and
(14) Guide dogs,
dog food, licenses, and veterinary services.
(f) If an
applicant uses funds in a MEAD employability account for items other than those
described in He-W 841.03(d)(3), the remaining funds in the account shall be
counted as a resource.
(g) Applicants
who have been determined eligible for medical assistance pursuant to He-W 841.03(a)
and who subsequently become unemployed but
who intend to return to work shall remain eligible for MEAD for a 6-month
extension period beginning with the date the individual becomes unemployed, if:
(1) The
recipient was involuntarily terminated from employment, or seasonal work ended,
and is currently seeking new employment; or
(2) The recipient
voluntarily terminated employment with good cause in accordance with (i) below.
(h) A recipient who has completed the 6-month
extension may obtain one additional 6-month extension if the recipient provides
either:
(1) A doctor’s
written statement regarding the individual’s medical condition as it relates to
their inability to work; or
(2) Written
documentation of proven job search through contacts made to employers, and/or
employment agencies such as One-Stops, Vocational Rehabilitation, or Employment
Networks.
(i) The
division of family assistance shall determine that good cause for leaving
employment exists, in accordance with RSA 167:82, III(c)(1), (2), (4), (6),
(7), and (8).
(j) A recipient
shall be terminated from MEAD when 3 consecutive occurrences of employment by a
recipient indicate that the date of hire occurred during the last month of each
of the 6-month periods.
Source. #13380, eff
5-25-22
PARTS He-W
838 through He-W 843 – RESERVED
PART He-W
844 Technical Requirements for Adult
Medical Assistance
He-W
844.01 Personal Interview.
(a) A personal interview between the individual
or authorized representative (AR) and a department staff member or contracted
employee shall be required for:
(1) Each initial
determination of eligibility for adult category medical assistance; and
(2) Each regularly
scheduled redetermination of eligibility for all adult category individuals
except for:
a. Individuals who
receive in and out medically needy medical assistance pursuant to He-W 878.01;
b. Individuals residing in independent living arrangements
and not receiving SNAP benefits; and
c. Individuals
residing in nursing facilities or swing-bed hospitals, as defined in 42 CFR
413.114(b), and receiving payments for nursing care or who are only eligible for
medical services other than a payment for nursing care.
(b) When required for nursing facility, choices
for independence (CFI), home and community-based care for the developmentally
disabled (HCBC-DD), home and community-based care for individuals with an
acquired brain disorder (HCBC-ABD), and home and community-based care for
in-home supports (HCBC-IHS) cases, a department staff member shall conduct a
personal interview with one or more of the following:
(1) The individual;
(2) A representative of the nursing facility or swing-bed hospital
as defined in 42 CFR 413.114(b); or
(3) The individual’s
relative or AR.
(c) A personal interview shall be conducted for
all adult category cases, including those exempted above in (a)(2), as a result
of reported changes or the discovery of conflicting information related to
eligibility.
(d) A personal interview shall be required once
during a 12-month period for any adult category case on a more frequent
redetermination of assistance schedule pursuant to He-W 684.02(d).
(e) The individual or the individual’s AR shall
review the summary of the information provided during the interview with the
department’s representative who conducted the interview, and:
(1) Make any
corrections to the information; and
(2) Sign the summary
attesting to the truthfulness and accuracy of the information provided.
Source. #12714, eff
1-23-19
PARTS He-W 845 through He-W 847 – RESERVED
PART He-W 848
RESIDENTIAL CARE FACILITIES AND COMMUNITY RESIDENCES
He-W
848.01 RESERVED
He-W 848.02 Residential Care Facilities.
(a)
Individuals living in residential care facilities, as described in RSA
151:2, I(e), shall meet all general, technical, categorical, and financial requirements
for adult category medical assistance, in addition to the requirements below.
(b)
Individuals living in residential care facilities shall be entitled to a
different standard of need than individuals residing in independent living
arrangements when the residential care facility is licensed by the department
as meeting the standards for the care of residential care facility residents.
(c)
Financial eligibility for individuals in residential care facilities
shall be determined as an assistance group size of one.
(d) The standard of need for an individual in a
residential care facility shall be adjusted annually as specified in He-W
648.04.
Source. #12179, eff
5-23-17
He-W 848.03 Community
Residences.
(a) Individuals living in community residences,
as defined in He-M 1001.02(k), shall meet all general, technical, categorical, and financial requirements for adult category medical
assistance, in addition to the requirements below.
(b) Individuals living in community residences
shall be entitled to a different standard of need than individuals residing in independent living arrangements when:
(1) The community
residence is certified or licensed by the department;
(2) The individual has
been determined appropriate for community residence care by a division of developmental
services area agency case manager; and
(3) The individual has
been placed in a community residence.
(c) Financial eligibility for individuals in
community residences shall be determined as an assistance group size of one.
(d) The standard of need shall be adjusted
annually, as specified in He-W 648.04, for individuals living in:
(1) Community
residences, as defined in He-M 1001.02(k); and
(2) Family residences,
as defined in He-M 1001.02(k) and He-M 1001.02(p).
Source. #12179, eff
5-23-17
PARTS He-W 849 –through He-W 851 RESERVED
PART He-W 852
INCOME – BASIC PRINCIPALS
He-W 852.06 Fluctuating Income.
(a)
"Best estimate" means an expectation of income to be received
by an individual determined by evaluating past, present, and anticipated significant
and non-significant income changes.
(b)
"Fluctuating income" means:
(1) Earned income that varies from month to month
such as when an individual works varying hours, overtime, or on a piece work
basis; or
(2) Unearned income that varies from month to
month due to changes in frequency or amount.
(c)
"Non-significant changes" means any temporary or short-term
variations in the amount of earned or unearned income caused by a situation
which is not ongoing.
(d)
"Significant changes" means changes in sources or amounts of
earned or unearned income which are:
(1) Expected to continue into the future; or
(2) Short-term because it is caused by a
situation which is not ongoing.
(e)
The department of health and human services (DHHS) shall convert
fluctuating income to a monthly amount pursuant to He-W 652.05 by averaging
income for the most recent consecutive 4 weeks when such income represents a
best estimate of future income pursuant to (a) above as verified by pay stubs or
a statement from the employer.
(f) Income received during weeks with
non-significant income changes pursuant to (c) above shall not be used to
determine the average monthly amount.
(g)
When the average monthly amount determined in (e) above does not
represent a best estimate of future income pursuant to (a) above, the average
monthly amount shall be determined as follows:
(1) Only data for weeks that accurately represent
past earnings, up to a maximum of 8 weeks’ data, shall be included;
(2) The average weekly income shall be determined
using the data from the weeks identified in (g)(1) above; and
(3) The appropriate multiplier under He-W 652.05
shall be used to convert average weekly income to a monthly amount.
(h)
When income has been received for less than 4 consecutive weeks, the
best estimate of future income pursuant to (a) above, shall be determined by
computing a monthly average based on the actual number of weeks the income was
received.
(i) The following shall apply to self-employment
income:
(1) If self-employment
income is the only income received from employment in a 12-month period, it will
be averaged over a 12-month period;
(2) If self-employment
income is the only income received from employment in a period of fewer than 12
months, it will be averaged over the number of months it was received; and
(3) If self-employment
income is not the only income received from employment, it will be treated as
income in the months received and will not be averaged.
(j)
The estimated average monthly gross earned income as defined in He-W
601.04(m), shall be used until the next redetermination of eligibility.
(k)
The estimated average monthly gross earned self-employment income as
defined in He-W 601.04(n), shall be used for one year.
Source. #12616, eff
8-30-18
He-W 852.07 Developing Potential Sources of Income or
Benefits.
(a)
To be eligible for adult category medical assistance, an individual
shall apply for all potential sources of income or benefits, including, but not
limited to:
(1) Benefits described under Title II of the
Social Security Act;
(2) Veteran's benefits, including the veteran's
affairs aid and attendance allowance;
(3) Retirement benefits or pensions;
(4) Disability benefits or pensions;
(5) Unemployment or worker's compensation;
(6) Contributions from any liable third-party;
and
(7) Third-party medical coverage.
(b)
The application for other income or benefits described in (a) above
shall be made no later than 30 days after the referral for those benefits.
(c)
If the individual is incapable of applying for the aid and attendance
allowance pursuant to (a)(2) above, does not have an authorized representative
to apply on the individual's behalf, and the nursing facility will not apply on
the individual's behalf, the eligibility worker shall initiate the application
for the aid and attendance allowance on the individual's behalf.
(d)
When applying for the other income or benefits described in (a) above, applicants
and recipients of adult category medical assistance shall:
(1) Provide all
required information and verification and complete all forms as required in the
application process for the other income or benefits;
(2) Cooperate with the
eligibility-determining agencies or the sources of the other income or benefits
in taking all necessary steps to obtain the other income or benefits, subject
to the limitations in (d)(4) below;
(3) the other income or benefits, if
eligible;
(4) Pursue all appeal
options within the timeframes set by the eligibility-determining agencies or the
sources of the other income or benefits described in (a) above, up to, but not
including, court action, if found ineligible for the benefit due to medical reasons;
and
(5) Be exempt from developing potential sources of other income or
benefits if good cause exists in accordance with (f) and (g) below.
(e)
Medical assistance for all the adults in the assistance group shall be
denied or terminated if an individual is ineligible for the other income or benefits
described in (a) above due to refusal or failure to comply with the
requirements of (d) above.
(f)
If determined to have good cause pursuant to (g) below, an adult category
medical assistance applicant or recipient shall be exempt from developing
potential sources of other income or benefits until the individual's next
redetermination, at which time the exemption shall be reviewed and, if the
individual continues to have good cause pursuant to (g) below, the exemption
shall be extended until the next regularly scheduled redetermination.
(g)
An adult category medical assistance applicant or recipient shall be determined
to have good cause if the individual verifies that a physical, mental, educational,
or linguistic limitation prevented the individual from:
(1) Applying for the other income or benefits
described in (a) above; or
(2) Taking other necessary steps to obtain the other
income or benefits, as described in (d) above.
Source. #13121, eff
10-21-20
PART He-W 853
RESERVED
PART He-W 854 EVALUATION AND TREATMENT OF INCOME
He-W
854.02 Income Computation.
(a) In computing eligibility and benefits, if any
subtraction results in a negative amount, the result shall be considered to be
zero instead of the negative amount.
(b) For individuals not living in nursing
facilities who are applying for or receiving adult category medical assistance,
and, if applicable, their applicant spouses, as defined in He-W 601.01(o), net
income, as defined in He-W 601.05(v), shall be computed as follows:
(1) The amount of the
individual’s and the individual’s applicant spouse’s countable gross earned
income, as defined in He-W 601.04(m)-(n), shall be determined;
(2) For each
individual, the earned income disregard for the adult category under which each
individual is applying or receiving assistance, as specified in He-W 654.15,
shall be computed and subtracted from each individual’s countable gross earned
income to obtain each individual’s net earned income, as defined in He-W
601.05(u);
(3) The individual net
earned income amounts shall be added together to obtain the assistance group’s
(AG’s) net earned income amount;
(4) The countable
gross unearned income, as defined in He-W 601.08(k), of each individual shall
be added to the AG’s net earned income;
(5) From the total in
(4) above, the adult standard disregard, as specified in He-W 854.16, and
allowable deductions, as specified in He-W 854.20 and He-W 654.21, shall be
subtracted; and
(6) The result shall
be the AG’s net income.
(c) For individuals not living in nursing
facilities who are applying for or receiving APTD or OAA medical assistance,
and who live with their nonapplicant spouses, as defined in He-W 601.05(x), net
income, as defined in He-W 601.05(v), shall be computed as follows:
(1) The countable
gross earned incomes of the applicant and nonapplicant spouse shall be
combined;
(2) The earned income
disregard shall be subtracted from the combined gross earned income determined
in (1) above to obtain the AG’s net earned income, except as follows:
a. For APTD medical
assistance applicants, allowable impairment related work expenses (IRWEs), as
described in 20 CFR 416.1112, shall be subtracted from the gross earned income
of the applicant only, and not subtracted from the gross earned income of the
nonapplicant spouse; and
b. For OAA medical assistance recipients, the IRWE deduction shall be
subtracted only when the recipient’s case is transferred from APTD medical assistance
to OAA medical assistance;
(3) The countable
gross unearned income, as defined in He-W 601.08(k), of all AG members shall be
added to the AG’s net earned income amount determined in (2) above;
(4) From the total in
(3) above, the adult standard disregard, as specified in He-W 854.16, and
allowable deductions, as specified in He-W 854.20 and He-W 654.21, shall be
subtracted; and
(5) The result shall
be the AG’s net income as defined in He-W 601.05(v).
(d) For individuals applying for or receiving ANB
medical assistance who live with their nonapplicant spouses as defined in He-W
601.05(x), eligibility and level of benefits shall be computed as in (c) above,
except that the individualized plan for employment work expenses subtracted
from the applicant’s earned income shall be those described in He-W 654.15(d).
(e) For individuals living in nursing facilities
who are applying for or receiving OAA, APTD or ANB, gross income for purposes of
determining categorical eligibility for nursing facility care, as defined in
He-W 858.05, shall be computed by adding together the individual’s countable
gross earned income and countable gross unearned income.
(f)
The amount of an individual’s net income for purposes of determining
eligibility for nursing facility care as medically needy, as defined in He-W 858.05,
shall be computed as follows:
(1) The earned income
disregard for the adult category under which the individual is applying for or
receiving assistance, as defined in He-W 654.15, shall be subtracted from the
individual’s countable gross earned income to obtain the individual’s net
earned income;
(2) The individual's countable
gross unearned income shall be added to the net earned income; and
(3)
The allowable deductions, as specified in He-W 854.20 and He-W 654.21,
shall be subtracted, in order, from the amount in (2) above to arrive at the
individual’s net income as defined in He-W 601.05(v).
Source. #12050, eff
11-19-16
He-W 854.15 Adult
Category Earned Income Disregard.
(a) The
earned income disregard shall be the first subtraction from earned income when
computing net income for the adult categories of medical assistance.
(b) For
aid to the permanently and totally disabled (APTD) or old age assistance (OAA)
medical assistance applicants and recipients and for their applicant spouses
who are also applying for APTD or OAA medical assistance, the earned income
disregard for each individual shall consist of the amounts specified in 20 CFR
416.1112 for supplemental security income (SSI) recipients.
(c) For
aid to the needy blind (ANB) medical assistance applicants and recipients and
for their applicant spouses who are also applying for ANB, the earned income
disregard for each individual shall be the first $85.00 of each individual's
monthly gross earned income plus one half of the remaining amount.
(d) ANB
medical assistance applicants and recipients shall have additional
employment-related amounts added to the earned income disregard if:
(1) There is an individualized plan for employment
for a specified period of time which has been approved by the New Hampshire department
of education and meets the requirements cited in 29 USC 720 et. seq.; and
(2) The plan described in (1) above requires the
use of additional disregards.
(e) For
ANB medical assistance applicants and recipients with applicant spouses who are
applying for APTD or OAA, the computation method for determining the amount of
the earned income disregard for the spouse shall be the method to determine the
APTD or OAA earned income disregard in (b) above for medical assistance.
(f) For
APTD or OAA medical assistance applicants and recipients with applicant spouses
who are applying for ANB, the computation method for determining the amount of
the earned income disregard for the spouse shall be the method to determine the
ANB earned income disregard in (c) and (d) above.
(g) For
an adult category assistance group which includes a non-applicant spouse, as
defined in He-W 601.05(t), the computation method for determining the amount of
the earned income disregard to be applied to the medical assistance case shall
be the method specified in 20 CFR 416.1112(c) for SSI recipients.
Source. #13525, eff
1-24-23
He-W
854.16 Adult Standard Disregard.
(a) For medical assistance applicants or
recipients who do not reside in nursing facilities, a standard disregard shall
be subtracted from income as described in He-W 654.02(c)(5).
(b) The amount of the disregard shall depend on
the number of individuals whose needs are considered when determining
eligibility, as follows:
(1) The standard disregard for one individual
shall be $13.00;
(2) The standard disregard shall be $20.00 for an
individual and applicant or nonapplicant spouse, or an individual and a needy
essential person; and
(3) The standard disregard shall be $25.00 for an
individual and applicant or nonapplicant spouse and a needy essential person.
Source. #11042, eff
2-24-16
He-W 854.17 Post-Eligibility Computation of Cost of
Care for Nursing Facility Care.
(a)
The amount of income that an eligible individual residing in a nursing
facility is liable to contribute toward the cost of his or her nursing facility
care shall be computed as follows:
(1) The amount of the applicant or recipient’s
gross earned income as defined in He-W 601.04(m) shall be determined;
(2)
The employment expense disregard, as specified in He-W 654.18, shall be
subtracted from the individual's gross earned income to obtain the individual’s
net earned income;
(3)
The total amount of the individual's unearned income, as defined in He-W
601.08(k), shall be added to the net earned income to determine the individual’s
net income;
(4)
The allowable deductions, as defined in He-W 854.20 and He-W 654.21,
shall be subtracted from the individual’s net income;
(5)
The veterans affairs nursing facility pension, as defined in 38 U.S.C.
5503, if received, or the personal needs allowance, as described in (b) below,
shall be subtracted from the amount in (4) above;
(6)
The amount of income to be allocated to a spouse or dependents, as
described in He-W 654.21, shall be subtracted from the amount in (5) above;
(7)
The cost of the following medical expenses incurred by the recipient
shall be subtracted from the amount in (6) above:
a. Health insurance premiums, including
Medicare Part B, coinsurance payments, and deductibles;
b.
Necessary and remedial care that would be covered by medical
assistance except that allowable payment limits have been exceeded;
c.
Necessary and remedial care that is recognized by state law, but not
covered by medical assistance; and
d.
Currently obligated, unpaid prior medical debt;
(8)
The amount of any continuing SSI benefits, under 42 USC 1382(e), shall
be subtracted from the amount in (7) above;
(9) If a physician has verified the stay in the
nursing facility is to be 3 months or less and the individual is expected to
return home, an amount equal to the FANF shelter payment allowance, as
described in He-W 658.02, shall be subtracted from the amount in (8) above;
(10) The veterans affairs aid and attendance
allowance shall be added to the amount in (8) or (9) above as required by 42
CFR 435.733(c); and
(11)
The result in (10) above shall be the amount of income for which the
individual is liable to remit to the nursing facility as payment toward the
cost of his or her nursing facility care.
(b)
The personal needs allowance (PNA) shall be equal to the minimum amount
mandated by RSA 167:27-a, I and, pursuant to RSA 167:27-a, II, updated every 5
years by:
(1)
Multiplying the current year’s PNA by the sum of the previous 5 years’
cost of living adjustments as described in 20 CFR 416.405;
(2)
Rounding up the product derived in (b)(1) above to the next whole
dollar; and
(3)
Adding the rounded up product in (b)(2) above to the current year’s PNA.
(c)
For all individuals applying for nursing facility care:
(1)
Only the following currently obligated, unpaid prior medical debts shall
be allowed:
a.
Non-nursing facility-related medical expenses; and
b.
Nursing facility expenses at the Medicaid provider payment rate for
the facility.
(2)
Nursing facility expenses incurred during any penalty period pursuant to
He-W 601.06(h), or period of ineligibility pursuant to He-W 601.06(i), except as noted in (c)(3) below, shall not be
considered an allowable medical debt pursuant to (a)(7)(d) above; and
(3)
Nursing facility expenses incurred during a period of ineligibility due
to excess resources or receipt of a lump sum shall be considered an allowable
medical expense pursuant to (a)(7)d. above, and in accordance with (c)(1)b.
above.
Source. #11042, eff
2-24-16 (formerly He-W 654.17)
He-W
854.18 Adult Employment Expense Disregard.
(a)
Expenses which are reasonably
attributable to the earning of income shall be subtracted from the earned
income of individuals living in nursing facilities who are receiving OAA, APTD
or ANB when determining the amount of the individual’s cost of care liability
as defined in He-W 854.17.
(b) The amount of the employment expense
disregard shall be either a flat rate of $18.00 per month, or the amount of actual
verified expenses if higher than $18.00 per month.
(c) The following expenses, if actually incurred
and verified, shall be considered reasonably attributable to the earning of
income:
(1) Social security
taxes, at the rate set by SSA;
(2) Railroad
retirement taxes;
(3) Federal withholding
taxes, corresponding to the number of exemptions which the individual is
legally entitled to claim;
(4) Mandatory retirement
payments;
(5) Mandatory union
dues;
(6) Other mandatory
deductions from wages provided that the individual can document that the
payroll deduction is not elective;
(7) Costs for transportation
to and from work or to and from child care when child care is necessary for
employment, subject to the following conditions:
a. To qualify as an allowable employment expense, the transportation used
shall be the least expensive reasonable means available to the individual;
b. The amount of allowable
transportation costs shall be computed by multiplying the average number of
days per month an individual is employed, without deducting temporary absences
of short duration, by the transportation cost for one day;
c. If the individual
has been or will be reimbursed for transportation costs in any manner, the amount of the reimbursement shall be subtracted from the amount
that would otherwise be allowed;
d. For travel incurred
by an individual using his or her own vehicle, the allowable transportation cost shall be $0.21
per mile multiplied by the number of miles anticipated to be traveled in a
month;
e. For travel provided in another
person's privately owned vehicle, the allowable transportation cost shall be as
charged up to the amount that would be allowed if the individual used his or her own vehicle; and
f. For travel provided by public transportation, such as by taxi or bus,
the allowable transportation cost shall be the amount charged the public for
such travel;
(8) Costs for uniforms
and other unique clothing required for employment and not worn outside the work
environment, subject to the following conditions:
a. Cleaning of uniforms shall not be an allowable employment
expense unless the individual can document that a standard of cleanliness requires professional
cleaning as a condition of employment;
b. The allowable
expense shall be the amount actually paid by the individual for the special
clothing;
c. If the amount varies
monthly, an average shall be computed and applied until the next regularly scheduled redetermination; and
d. If the individual
has been or will be reimbursed in any manner for a claimed special clothing
expense, the reimbursed amount shall be subtracted from the amount which would
otherwise be allowed; and
(9) Other mandatory
employment related expenses claimed and verified by the individual.
Source. #12050, eff
11-19-16
He-W 854.20 Allowable Deductions.
(a)
When determining eligibility and the amount of assistance for all
categories of medical assistance, an allowable deduction from the income
available to the assistance group shall be made, in an amount which has been or
must be paid by an individual for non-employment-related types of expenses,
including the following:
(1)
Training expenses as described in (e) below;
(2)
Garnishments from an individual’s earnings to repay a legal debt;
(3)
Allocated income, as specified in He-W 654.21; and
(4)
Any court-ordered payments, as described in (f) below, including but not
limited to child support, alimony, and guardianship fees.
(b)
The deduction described in (a) above shall be allowed for:
(1)
Any individual whose needs are included in the assistance group; and
(2)
Any individual whose income is counted even if his or her needs are not
included in the assistance group.
(c)
The amount of the deduction shall be the amount of the verified expense.
(d)
Allowable deductions shall be applied as follows:
(1)
For medical assistance non-nursing facility cases in which there is a
nonapplicant spouse, the allowable deductions shall be subtracted from the
amount which represents the monthly combined earned income, less all applicable
disregards to earned income as described in He-W 654.14 and He-W 654.15, plus
all unearned income;
(2)
For adult category non-nursing facility cases in which there is an applicant
spouse, the allowable deductions shall be subtracted from the amounts which
represent the individual monthly net incomes of the applicant and the applicant
spouse; and
(3)
For nursing facility cases, allowable deductions shall not be subtracted
for the categorically needy eligibility determination as described in He-W 654.02,
but shall be the first subtraction from the net income amount for the medically
needy eligibility determination as described in He-W 654.02.
(e)
Training expenses shall be an allowable deduction when all the following
circumstances are met:
(1)
The individual is enrolled in and regularly attending at least on a half-time
basis, a program having an organized curriculum with the specific objective of
training individuals for gainful employment;
(2)
The training program is sponsored by public education or the federal
government, or is offered by private schools for a particular trade;
(3)
The individual has not received reimbursement for the training expense
from any other source, or if partial reimbursement is made, the remaining
expense shall be an allowable deduction;
(4)
The training expense is not part of an employment expense disregard,
because the individual has no earned income, or the training is totally
unrelated to the individual's employment; and
(5)
The expense occurs on at least a monthly basis.
(f)
Any court-ordered payment which must be paid by an individual shall be
an allowable deduction, regardless of whether the individual actually makes the
payment.
Source. #11042, eff
2-24-16
PART He-W 855
RESERVED
PART He-W 856
RESOURCES
He-W
856.01 Resources - Basic Principles.
(a) Except where otherwise provided or
specifically prohibited by federal law, resources shall be evaluated and
treated the same for all categories of medical assistance that use a resource
test in the eligibility determination process.
(b) The department's state spousal resource
standard shall be the minimum standard required by 42 USC 1396r-5(f) and (g).
(c) As required by 42 USC 1396r-5(e)(2)(C), there
shall be substituted for the community spouse resource allowance, pursuant to
42 USC 1396r-5(f)(2), an amount adequate to raise the community spouse's income
up to the maximum maintenance allowance if all of the following conditions are
met:
(1) The institutionalized spouse has allocated
the maximum amount of income allowed pursuant to He-W 654.21(h); and
(2) An administrative appeals officer determines
that the community spouse resource allowance, in relation to the amount of
income generated by such an allowance, is inadequate to raise the community
spouse's income to the maximum maintenance allowance specified in 42 USC
1396r-5(d).
(d) For purposes of evaluating and treating resources,
individuals applying for or receiving home and community based care shall not
be considered institutionalized individuals except when evaluating asset
transfers.
Source. #10924, eff
10-1-15
He-W
856.02 Treatment of Specific Types of
Resources. Funds from an individual
development account used for unqualified purposes, pursuant to 42 USC 604(h),
shall be treated as lump sum payment in accordance with He-W 656.04(b)(10), for
the adult categories of medical assistance.
Source. #12481, eff
2-21-18
He-W
856.03 Jointly Owned Resources.
(a) Personal property resources established prior to
November 1, 1995, which an individual owns together with a non-assistance group
member who is not receiving assistance, shall be considered to be shared
equally among the owners, unless the individual verifies ownership of more or less
than an equal share. If the individual
verifies ownership of more or less than an equal share through documentary
evidence, only the amount of the share actually owned by the individual shall
count as a reSource.
(b) Personal property resources established on or
after November 1, 1995, which an individual owns together with an individual
who is not an applicant or recipient, shall be
considered to belong to the individual who is applying for or receiving
assistance. If there is more than one
individual who is applying for or receiving assistance that jointly owns the
resource, it shall be assumed that each individual owns an equal share.
(1) If an individual wishes to rebut the ownership presumption
in (b) above, the individual shall submit to the department all of the
following:
a. A statement from the individual describing the
portion of the personal property resources the individual claims to own, signed
and dated under penalty of unsworn falsification pursuant to RSA 641:3;
b. A corroborating statement from each other
account holder, with each statement signed and dated under penalty of unsworn
falsification pursuant to RSA 641:3;
c. If the only
other account holder is incompetent or a minor, a corroborating statement from
a competent adult aware of the circumstances surrounding establishment of the
account;
d. Account records showing deposits, withdrawals
and interest in the months for which ownership is an issue;
e. If the individual does not own any of the
funds, documentary evidence showing that the individual can no longer withdraw
funds from the account; and
f. If the individual owns only a portion of the
funds, documentary evidence showing removal from the account of such funds, or
removal of the funds owned by the other account holder(s), and redesignation of
the account.
(2) Any resources that the evidence establishes
were owned by the other account holder(s), as determined by the department, and
that the individual can no longer withdraw from the account shall not be
considered to be the individual's resources.
However, such resources shall be deemed available to the individual if
the account holder to whom they belong is someone whose resources would be used
in determining the individual's eligibility.
(3) Jointly owned real property shall be excluded
if the terms of ownership of the property prevent the individual from
unilaterally liquidating the property and the other owner or owners refuse to agree
to the sale. The addition of a joint owner shall be evaluated as an asset
transfer in accordance with He-W 620.01.
(4) To verify:
a. The terms of ownership of the jointly owned
real property which prevent the individual from unilaterally liquidating the
property pursuant to (3) above, the individual shall submit to the department
the deed, title, or other legally binding property document stating the terms
of property ownership; and
b. The other owner or owners refuse to agree to
the sale pursuant to (3) above, the individual shall submit to the department a
corroborating statement from each other account holder, with each statement
signed and dated under penalty of unsworn falsification pursuant to RSA 641:3.
Source. #10982, eff
11-24-15
He-W 856.04 Personal Property Resources.
(a) For all non-MAGI categories
of medical assistance except as specified in (11) and (12) below, personal
property resources shall be treated as follows:
(1) At application and
redetermination, the assistance group shall report and verify all resources;
(2) The value of accumulated
interest, the equity value of life insurance policies and the value of stocks
and bonds, when verified at application or redetermination, shall be considered
unchanged until the next redetermination;
(3) Changes to the
value of the resources identified in He-W 856.03(a) shall be reported between
redeterminations;
(4) Individuals shall report
the acquisition of new resources and the selling of existing resources, pursuant
to RSA 167:17;
(5) The following
resources shall not be counted when determining eligibility:
a. Borrowed money,
except for when the individual transfers the proceeds or a portion of the
proceeds of the loan to another individual pursuant to He-W 820.03(d)(7);
b. All household
items;
c. Inaccessible
personal property resources whose value is legally unobtainable by the individual,
except as specified in (7) below;
d. Group, term, and
fraternal life insurance policies which have no equity value and are only
payable upon the death of the insured;
e. Lump sum death
payments to cover funeral and burial expenses;
f. Resources resulting
from an accumulation of types of income that are excluded by federal mandate;
g. Federal, state, and
local income tax refunds; and
h. Keogh accounts
which involve a contractual relationship with a non-assistance group member,
provided the contract prevents the individual from withdrawing money from the
account without affecting the employer or other employees;
(6) All Individual
Retirement Accounts (IRA), one-person Keogh accounts, and non-contractual Keogh
accounts shall be counted towards the resource limit as follows:
a. The balance in the
account minus the penalty for early withdrawal for the entire account shall be
counted; and
b. The balance amount
and the amount of the penalty for early withdrawal shall be as specified on the
date on which they are initially verified and these amounts shall remain in
effect until the next redetermination;
(7) Trusts and similar legal devices shall be
treated as follows:
a. Trusts and similar
legal devices, including annuities, established after August 10, 1993, and
trusts and legal devices that were established prior to August 11, 1993 but
have been added to or otherwise augmented after August 10, 1993, shall be
treated in accordance with 42 USC 1396p(d)(1)-(3);
b. No clause or
requirement in the trust, no matter how specifically it applies to state or federal programs, shall preclude a
trust from being considered in accordance with 42 USC 1396p(d)(1)-(3);
c. Any payments from
revocable trusts, which are not made to, or on behalf of, the individual shall
be considered assets disposed of for less than fair market value pursuant to
He-W 820;
d. Payments of income
or payments from the corpus of irrevocable trusts that are not made to or for
the benefit of the individual, shall be treated as a transfer of assets for
less than fair market value pursuant to He-W 820;
e. Irrevocable trusts
where payments from some portions or all of the trust cannot under any
circumstances be made to, or for the benefit of, the individual shall be
treated as follows:
1. The portion of the
corpus or income on the corpus which cannot be paid to the individual shall be
treated as a transfer of assets and shall be treated in accordance with He-W 820;
2. In treating portions
of the corpus or income which cannot be paid to the individual as a transfer of
assets, the date of the transfer shall be the date the trust was established or,
if later, the date on which payment to the individual was restricted or
eliminated;
3. In determining the
value of the portion of the trust which cannot be paid to the individual for
transfer purposes, any payments made, for whatever purpose, after the date the
trust was established or, if later, the date payment to the individual was foreclosed,
shall not be subtracted from the value of the trust;
4. If funds were added
to that portion of the trust after these dates, those funds shall be considered
to be a new transfer of assets, effective on the date the funds are added to
the trust; and
5. The value of the
transferred amount shall be no less than its value on the date of establishment
or the date that access to the principal of the trust was restricted or
eliminated;
f. When some portion
of the corpus or income on the corpus of a trust is or can be paid to the
individual, such portion or income shall be treated in accordance with the
standards set forth in 42 USC 1396p(d)(3)(A) or (B), as applicable;
g. Payments shall be
considered to be made to the individual when any amount from the trust,
including an amount from the corpus, or income produced by the corpus, is paid
directly to the individual, or to someone acting on the individual's behalf;
and
h. Payments made for
the benefit of the individual shall be payments of any sort, including an
amount from the corpus, or income produced by the corpus, paid to another entity
such that the individual derives some benefit from the payment;
(8) An irrevocable burial trust established by an
individual for the purpose of paying, at some point in the future, for the
various expenses associated with the individual's funeral and burial shall be
an exempt trust if the individual has a signed contract with a funeral home and
the corpus of the trust does not exceed the contracted amount;
(9) Annuities shall be
excluded from the resource computation only if all of the following are true:
a. The expected return
on the annuity is commensurate with the life expectancy of the beneficiary in
accordance with He-W 820.03(l);
b. The annuity is owned
by an individual applying for medical assistance on or after November 1, 2003,
and the state of New Hampshire is selected as the:
1. Contingent
beneficiary in the event that the individual’s spouse, minor child, or
permanently and totally disabled child, if any, predeceases the individual; or
2. Secondary
beneficiary if the individual has no spouse, minor child, or permanently and
totally disabled child at the time the annuity is purchased; and
c. The annuity is
owned by an individual applying for medical assistance on or after November 1,
2003, and the payment structure provides equal or nearly equal payments to the
individual for the duration of the annuity;
(10) Annuities
excluded from the resource computation pursuant to (9) above shall be treated
as follows:
a. When an individual
cannot access the principal of an annuity, the annuity shall be treated as an
irrevocable trust;
b. If an annuity
provides for payments to be made to the individual, those payments shall be
considered unearned income to the individual;
c. Any portion of the
principal of the annuity that is paid to or on behalf of the individual shall
be considered unearned income to the individual; and
d. Portions of the
annuity that cannot be paid to or for the benefit of the individual shall be
treated as transfers of assets and shall be evaluated in accordance with He-W 820;
(11) Trusts described
in 42 USC 1396p(d)(4)(A) shall continue to be excluded when determining
eligibility for medical assistance-only even after the individual becomes age
65, except that any addition to the trust or augmentation of the trust after the
individual turns age 65 shall be treated as a transfer of assets for less than
fair market value;
(12) Trusts described
in 42 USC 1396p(d)(4)(C) shall include a provision specifically providing for
payment to the state pursuant to 42 USC 1396p(d)(4)(C)(iv); and
(13) Where application
of the trust provisions discussed in 42 USC 1396p(d)(4)(A) and (C) would cause
an undue hardship as specified in He-W 821.01(a)(6), those provisions shall not
apply.
(b) For the adult
categories of medical assistance, personal property resources, with the
exception of additional resources of individuals eligible for medicaid for employed adults with disabilities (MEAD) pursuant
to He-W 841.03, shall be treated as follows:
(1) The following
resources shall not be counted when determining eligibility for the adult
categories of medical assistance:
a. All vehicles such
as but not limited to cars, trucks, boats, motorcycles and snowmobiles; and
b. Farm machinery,
livestock, tools, and equipment;
(2) The equity value
of the following resources shall be counted when determining eligibility for
all adult categories of medical assistance:
a. Bank accounts,
including checking accounts;
b. Stocks and bonds;
and
c.
Pre-paid debit card,
such as Direct Express card;
(3) Accessible burial
funds shall be treated in the following manner:
a. Up to $1500 of the
burial funds shall not be counted when determining eligibility for the adult
categories of medical assistance when the value of the burial funds, added to the
individual’s other countable resources, exceeds the resource limits as specified
in He-W 856.06;
b. The amount of the
burial fund exclusion shall be reduced by:
1. The combined face
value of any life insurance policies; and
2. Any irrevocable trusts
or irrevocable funds identified as available to meet burial expenses;
c. Interest earned on
excluded burial funds and appreciation on the value of excluded burial
arrangements shall be excluded as a resource, if left to accumulate as part of
the separately identified burial fund;
d. Interest earned on
any portion of the burial fund not excluded as a resource shall be excluded
only if inaccessible to the individual; and
e. Accumulated
interest which is accessible to the individual shall be counted as a resource
at each eligibility determination;
(4) Resources set
aside under an
(5) Life insurance
policies shall be:
a. A countable
resource when
the combined equity value of all an individual’s policies exceeds $1,500; or
b. An excluded
resource when:
1. The total combined
equity value of all the individual’s policies is equal to or less than $1,500;
or
2. The combined equity
value of the individual’s policies exceeds $1,500, but the state of
(6) Applicants whose
life insurance policies have a combined face value exceeding $1,500 shall be
allowed to offset the excess equity value of life insurance for 3 months if:
a. The equity value of
life insurance exceeds resource limits in He-W 856.06, but other countable
resources do not exceed the resource limits; and
b. The applicant or
the applicant's legal spouse who is living with the applicant has incurred and
is liable for unpaid medical expenses;
(7) The excess value
of life insurance shall be offset as follows:
a. Unpaid medical
bills which were incurred before the period for which eligibility is requested
shall be deducted from the equity value of the life insurance policies;
b. If there are not
enough prior unpaid medical bills to offset the equity value of life insurance,
unpaid medical bills incurred within the period of which eligibility is
requested shall be deducted from the equity value of the life insurance
policies in chronological sequence, starting with the earliest unpaid bill;
c. The medical expense
offset shall occur prior to the determination of eligibility for in and out
medical assistance described in He-W 878.01; and
d. No incurred unpaid
medical bill shall be offset more than once;
(8) The period of
offsetting incurred medical expenses shall begin on the date that the applicant
provides verification to the department of health and human services (DHHS) of
resources and incurred medical expenses, and shall end 3 months thereafter;
(9) At the end of the
3 month period, the equity value of life insurance shall be counted in full
without any offset for medical expenses;
(10) Lump sum
payments, with the exception of lump sum earned income and excludable lump sum
payments paid to cover funeral expenses and portions of third party medical and
other expenses directly associated with receipt of the lump sum, shall be
counted as a resource when determining eligibility for the adult categories of medical
assistance; and
(11) For medical assistance services described in
He-W 820.03(s), entrance fees paid to a continuing care retirement community
(CCRC) shall be considered available to the individual if:
a. The entrance fee may be used to pay for care;
b. The individual is entitled to a refund when
the individual dies or terminates the CCRC; and
c. The entrance fee does not confer an ownership
interest in the CCRC.
(c) For the parents and other caretaker relatives
category of medically needy medical assistance, personal property resources
shall be treated as follows:
(1) Liquid resources
such as bank accounts, stocks, bonds, and savings certificates, owned by an
alien's sponsor or sponsor's spouse, shall be deemed to be available to the
alien when determining an alien's eligibility for parents and other caretaker
relatives category of medically needy medical assistance;
(2) Liquid resources
such as vehicles which are owned by an alien's sponsor or sponsor's spouse shall
not be deemed to be available to the alien;
(3) Junk vehicles used
only to supply parts for the individual's main vehicle, are in such dilapidated
condition that they cannot be reasonably repaired for sale or use, or which can
only be sold for scrap or parts, and vehicles which are jointly owned with a
non-assistance group member, shall be excluded as a resource when determining
eligibility for parents and other caretaker relatives category of medically
needy medical assistance;
(4) Lump sum payments
derived from converting a non-liquid resource to cash shall be counted as a
lump sum resource when determining eligibility for parents and other caretaker
relatives category of medically needy medical assistance;
(5) The remaining
balance of the working checking account and pre-paid debit card on the day it
is reviewed, reduced by the amount that represents the FANF payment standard
for an assistance group of comparable size with no income, shall be counted as
a resource for parents and other caretaker relatives category of medically
needy medical assistance;
(6) The following
special provisions shall apply to parents and other caretaker relatives
category of medically needy medical assistance recipients whose countable
resources exceed the allowable limit because their sole resources consist of
personal property assets which cannot be readily converted to cash, or which
consist of such assets and real property as follows:
a. Recipients shall
reduce excess resources to within allowable limits no later than the month
following the month in which resources first exceed the limit;
b. The recipient shall
verify the recipient is making a good faith effort to sell the personal
property resource which caused the resource limit to be exceeded; and
c. Medical assistance
shall terminate if the recipient fails to reduce resources within the above
time frames;
(7) The equity value
of each individual’s life insurance policies shall be counted as a resource
when determining eligibility for parents and other caretaker relatives category
of medically needy medical assistance, when the total combined value of the policies
is greater than $1,500;
(8) For the purposes of
the vehicle exclusion specified in RSA 167:81,IV(b), the total number of
vehicles excluded as a resource, regardless of ownership or value, should not to exceed the number of adult
members of the assistance group; and
(9) The equity value
of all life insurance policies shall be excluded as a resource when determining
eligibility for parents and other caretaker relatives category of medically
needy medical assistance, when:
a. The combined value of
each individual's policies is $1,500 or less; or
b.
The total combined value of each individual's policies exceeds $1,500,
but the state of
Source. #13395, eff
6-18-22
He-W 856.05 Real
Property Resources.
(a) For the adult categories
of medical assistance, real property resources shall be treated as follows:
(1) The home occupied
by the individual shall not be counted when determining eligibility for adult
categories of medical assistance;
(2) An unoccupied home
shall not be counted during periods of temporary absence such as short term hospitalization
or institutionalization;
(3) Income-producing
property, which is real property not occupied by the individual, but producing
income at least sufficient to meet the expenses of its ownership and
maintenance shall not be counted;
(4) Any real property
not otherwise excluded shall not be counted if it is necessary as the residence
for the individual’s spouse, minor child, or disabled child;
(5) One burial plot per
assistance group member shall not be counted; and
(6) The equity value
of real property which is not specifically excluded above shall be counted as a
resource
when determining eligibility for adult categories of medical assistance, except
during the 6 month disposal period described in subsection (b).
(b) For adult
categories of medical assistance, the assistance group shall take action to
dispose of the property within 6 months of being notified by the department of
health and human services (DHHS) that the property must be liquidated, and:
(1) The equity value
of the property shall not be counted during the disposal period; and
(2) The disposal
period shall be extended as long as:
a. The individual
verifies that action has been taken to sell the property and that there are
valid reasons for inability to sell the property; or
b. The individual’s hospitalization or institutionalization,
although long term, is not expected to be permanent and it is likely that the
individual will return to the home.
(c) If disposal does
not occur within the disposal period, as specified in (b) above, medical
assistance shall be denied or terminated.
(d) Applicants and
recipients of medical assistance described in He-W 820.01(q), whose equity
interest in their primary residence exceeds the 2016 limit of $552,000, updated
annually pursuant to 42 USC 1396p(f)(1)(C), shall not be eligible for such
services, but shall remain eligible for other medical assistance services,
unless the individual’s spouse, minor child or disabled child resides in the
property.
Source. #12217, eff
6-22-17
He-W 856.06 Resource Limits.
(a)
The resource limit for categorically needy medical assistance for home
care for children with severe disabilities (HC-CSD) shall be $1,000, regardless
of assistance group size.
(b)
The resource limit for adult categorically-needy medical assistance
shall be $1,500, with the exception of individuals eligible for medicaid for
employed adults with disabilities (MEAD) pursuant to He-W 641.03.
(c)
Except as described in (d) below, the resource limit for all categories
of medically-needy medical assistance shall be as follows, based on the number
of individuals in the assistance group:
(1) For a single individual, $2,500;
(2) For 2 individuals, $4,000; and
(3) For 3 or more individuals, add an additional
$100 for each additional individual in the assistance group to the resource
limit in (2) above.
(d)
The resource limit for applicants for medical assistance long-term care
services shall be $2,500 plus the value of coverage provided in a conforming
long-term care insurance policy, pursuant to RSA 167:4, IV(d) and 42 USC
1396p(b).
Source. #12017, eff
10-25-16
PART He-W 857 RESERVED
PART He-W 858
STANDARD OF NEED
Revision Note #1:
Document
#11169, effective 8-22-16, readopted with amendments He-W 658.04 titled “Protected
Income Level” and renumbered the rule as He-W 858.04. The source note information for He-W 876.01
prior to Document #11169 includes the documents filed under He-W 658.04.
Although He-W
658.04 had last been filed under Document #9208, effective 7-19-08, this rule
did not expire on 7-19-16 since it was extended pursuant to RSA 541-A:14-a until
replaced by He-W 858.04 in Document #11169, effective 8-26-16.
Revision Note #2:
Document
#12050, effective 11-19-16, included among other rules the readoption with amendments
of He-W 658.05 titled “Eligibility for Adult Category Medical Assistance Nursing
Care” and renumbered the rule as He-W 858.05.
Document #12050 also included the readoption with amendments of He-W
658.06 titled “Eligibility for Adult Category Medical Assistance for Choices for
Independence (CFI), Home and Community-Based Care for the Developmentally
Disabled (HCBC-DD), Home and Community-Based Care for Individuals with an
Acquired Brain Disorder (HCBC-ABD), and Home and Community-Based Care for In-Home
Supports (HCBC-HIS)” and renumbered the rule as He-W 858.06, now re-titled as
“Eligibility for Adult Category Medical Assistance for Home and Community-Based
Care Choices for Independence (HCBC-CFI), Home and Community-Based Care for the
Developmentally Disabled (HCBC-DD), Home and Community-Based Care for Individuals
with an Acquired Brain Disorder (HCBC-ABD), and Home and Community-Based Care
for In-Home Supports (HCBC-HIS)”.
The source
note information for He-W 858.05 and He-W 858.06 prior to Document #12050
includes the documents filed under He-W 658.05 and He-W 658.06, respectively.
Although He-W
658.05 and He-W 658.06 had last been filed as regular rules under Document
#9289, effective 10-3-08, these rules did not expire on 10-3-16 since they were
extended pursuant to RSA 541-A:14-a until replaced by He-W 858.05 and He-W 858.06
in Document #12050, effective 11-19-16.
He-W 858.04
Protected Income Level.
(a)
The department shall use a set of standards called the protected income
levels (PIL) to determine eligibility for all categories of medically needy medical
assistance, with the exception of individuals eligible for nursing facility
care, whose eligibility for medically needy medical assistance shall be
determined pursuant to He-W 658.05.
(b)
The maximum monthly PIL shall be as listed in Table 600.11, protected income
levels, below:
Table 600.11, Protected Income Levels
Assistance Group Size |
Protected Income Levels |
1 |
$591 |
2 |
$675 |
3 |
$683 |
4 |
$691 |
5 |
$698 |
6 |
$779 |
7 |
$842 |
8 |
$935 |
9 |
$987 |
10 |
$1064 |
11 |
$1151 |
12 |
$1223 |
For each additional person over 12, $67
shall be added. |
Source. (See Revision Note #1 at Chapter Heading He-W
600) #5171, eff 6-26-91; ss by #5530, eff 12-16-92; ss by #6865, eff 10-3-98; amd by #6952, eff 3-1-99; ss by #7226, eff 4-1-00; amd by #7451, eff 2-17-01; amd by
#7622, INTERIM, eff 1-9-02 EXPIRED: 7-8-02; amd by #7693, eff 5-25-02; amd by
#7803, INTERIM, eff 1-1-03, EXPIRED: 6-30-03; amd by #7876, eff 4-23-03; amd by
#8015, eff 1-1-04, EXPIRED: 6-29-04; amd
by #8092, eff 5-28-04; amd by #8252, eff 1-8-05; amd by #8433, eff 9-21-05 ss by #9111, INTERIM, eff
3-24-08, EXPIRES: 9-20-08; ss by #9208, eff 7-19-08; ss by #11169, eff 8-26-16
(See Revision Note #1 at Part heading for He-W 858)
He-W
858.05 Eligibility for Adult Category
Medical Assistance Nursing Care.
(a) The nursing facility cap shall be 300% of the
maximum SSI benefit for an eligible individual as determined in accordance with
20 CFR 416.410, adjusted by cost-of-living increases pursuant to 20 CFR
416.405.
(b) The individual shall be income eligible for
nursing facility care as categorically needy when the individual’s monthly gross
income, as defined in He-W 601.04(o), is less than or equal to the nursing
facility cap specified in (a) above.
(c) The individual shall be income eligible for
nursing facility care as medically needy when:
(1) The individual's monthly gross income, as defined in He-W
601.04(o), exceeds the nursing facility cap specified in (a) above; and
(2) The individual’s net income, as defined in He-W 601.05(v), is less than or
equal to the monthly medicaid nursing facility rate, as defined in He-E
806.01(aa).
(d)
When determining resource eligibility for nursing facility care as categorically
needy, $1,000 of the individual’s resources shall be disregarded.
Source.
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91;
ss by #5316, eff 1-27-92; ss by #5561, eff 1-22-93; ss by #5790, eff 2-22-94;
ss by #5966, eff 1-27-95; amd by #6969, eff 4-1-99;
ss by #7824, eff 2-8-03; ss by #9289, eff 10-3-08; ss by #12050, eff 11-19-16 (See
Revision Note #2 at Part heading for He-W 858)
He-W 858.06 Eligibility
for Adult Category Medical Assistance for Home and Community-Based Care Choices
for Independence (HCBC-CFI), Home and Community-Based Care for the
Developmentally Disabled (HCBC-DD), Home and Community-Based Care for
Individuals with an Acquired Brain Disorder (HCBC-ABD), and Home and Community-Based
Care for In-Home Supports (HCBC-IHS).
(a) The individual
shall be income eligible for HCBC-CFI, HCBC-DD, HCBC-ABD, or HCBC-IHS services
as medically needy when:
(1) The individuals’
monthly gross income, as defined in He-W 601.04(o), exceeds the nursing
facility cap specified in He-W 858.05(a); and
(2) The individual’s
net income, as defined in He-W 601.05(v), is equal to or less than the PIL, as
specified in He-W 858.04(b).
(b) If the individual’s net income in (a)(2) above
exceeds the protected income level (PIL), medically needy income eligibility
shall be determined in accordance with He-W 878.01.
(c) When
determining resource eligibility for individuals described in 42 CFR 435.217(a)
at the categorically needy level, $1,000 of the individual’s resources shall be
disregarded.
Source.
#7223, eff 3-30-00; ss by #9111, INTERIM, eff 3-24-08, EXPIRED: 9-20-08
New. #9289, eff 10-3-08; rpld
by #9499, EMERGENCY RULE, eff 6-30-09; ss by #9289, eff 10-3-08, reinstated by
REPEAL OF EMERGENCY RULE, #9524, eff 7-31-09; ss by #12050, eff 11-19-16 (See Revision
Note #2 at Part heading for He-W 858)
PARTS He-W 859 through He-W 863 & PARTS
He-W 865 through He-W 875 RESERVED
PART He-W 864
MEDICALLY NEEDY MEDICAL ASSISTANCE
He-W
864.01 RESERVED
He-W 864.02 Parents and Other Caretaker Relatives Medically
Needy Medical Assistance.
(a) The following individuals, who are residing
in the same housing unit, shall be included in the budgetary unit, as defined in He-W 601.02(e), when determining an individual’s
eligibility for parents and other caretaker relatives medically needy medical
assistance:
(1) All children who
meet the age criteria for dependent child, who are siblings, half siblings, and
step siblings; and
(2) All of the
children’s natural parents, stepparents, and caretaker relatives, as defined in
He-W 601.02(h), who are receiving assistance.
(b) For pregnant women, in addition to the individuals
listed in (a), the following shall be included in the budgetary unit:
(1) Unborn child(ren);
and
(2) The father of the
unborn child(ren) if he is married to and residing with the pregnant woman.
(c) Individuals listed in (a) or (b) above who are
recipients of federal supplemental security income (SSI) or adult category
financial assistance shall not be included in the budgetary unit except when their own eligibility is
being determined.
(d) The countable net income of non-SSI spouses
or parents shall be treated as follows in determining an individual’s eligibility:
(1) The countable net
income shall be prorated according to the total number of individuals in the
budgetary unit; and
(2) The prorated
amount shall then be multiplied by the total number of individuals in the
budgetary unit to determine each individual’s eligibility.
Source. #12773, eff 5-7-19 (formerly He-W 664.02)
PART He-W 876
NURSING FACILITIES
Revision Note:
Document #10895, effective 7-22-15,
readopted with amendments He-W 676.01 titled “Financial Eligibility for Nursing
Facilities” and renumbered the rule as He-W 876.01. The source note information for He-W 876.01 prior
to Document #10895 includes the documents filed under He-W 676.01.
Although He-W 676.01 had last been
filed under Document #8903, effective 6-28-07, this rule did not expire on
6-28-15 since it was extended pursuant to RSA 541-A:14-a until replaced by He-W
876.01 in Document #10895, effective 7-22-15.
He-W 876.01
Financial Eligibility for Nursing Facilities.
(a) The
department shall provide medical assistance for all the dates for which payment
is requested when the following criteria have been met:
(1) The
individual has been determined eligible for categorically or medically needy
medical assistance;
(2) The
individual has been determined eligible for a medical service for all dates for
which medical payment is requested;
(3) The
individual has satisfied all procedural requirements; and
(4) The
individual has been physically placed at the proper level of care.
(b)
Each individual applying for or in nursing facility care shall be
treated as an assistance group of one.
(c) If
the individual's net income, as defined in He-W 601.05(v), is greater than the
rate of the nursing facility, the individual shall be eligible for in and out
medically needy medical assistance, as defined in He-W 601.05(b), and the cost
of the nursing facility care shall be an allowable expense for spending down to
the protected income level, as defined in He-W 601.06(s).
(d) Nursing care payments shall be made only on behalf
of individuals in licensed, certified nursing facilities.
(e)
Individuals in licensed but uncertified nursing facilities shall be
considered to be residing in an independent living arrangement.
(f) The
nursing facility rate used in determining eligibility shall remain in effect
until the next eligibility determination.
(g) The
veteran’s affairs aid and attendance allowance shall be used in full to offset
the cost of nursing facility care.
(h) A
deduction for the cost of health insurance shall be allowed regardless of
whether the expense is mandatory or voluntary.
(i) Whenever health insurance premiums are due
more frequently than monthly, the cost shall be converted to a monthly amount
in accordance with He-W 652.05.
(j) Whenever
health insurance premiums are due less frequently than monthly, the cost shall
be averaged over the period it is intended to cover in order to obtain a
monthly amount.
Source.
(See Revision Note #1 at Chapter heading for He-W 600) #5171, eff 6-26-91;
ss by #5565, eff 2-8-93; ss by #6955, eff 3-3-99; ss by #8783, INTERIM, eff
12-30-06, EXPIRES: 6-28-07; ss by #8903, eff 6-28-07; ss by #10895, eff 7-22-15
(See Revision Note at Part heading for He-W 876)
PART He-W 877
RESERVED
PART He-W 878 IN AND
OUT MEDICALLY NEEDY MEDICAL ASSISTANCE
Revision Note:
Document #10743, effective 12-12-14, readopted with amendments
He-W 678.01 titled “In and Out Medically Needy Medical Assistance”, the only rule
in Part He-W 678 similarly titled “In and Out Medically Needy Medical Assistance”,
and renumbered the rule as He-W 878.01 in a new Part He-W 878, both titled “In
and Out Medically Needy Medical Assistance”.
The source note information for He-W 878.01 prior to Document #10743 includes
the documents filed under He-W 678.01.
Although He-W 678.01 had
last been filed under Document #8684, effective 7-21-06, this rule did not
expire on 7-21-14 since it was extended pursuant to RSA 541-A:14-a until
replaced by He-W 878.01 in Document #10743, effective 12-12-14.
He-W 878.01 In and Out Medically Needy Medical
Assistance.
(a) The department shall provide in and out medically
needy medical assistance in accordance with 42 CFR 435.301 to individuals:
(1) Who meet all
categorical, technical, and resource requirements for medically needy medical
assistance;
(2) Whose income
exceeds the protected income level for medically needy medical assistance; and
(3) Whose incurred
medical expenses and obligated prior medical debts, including non-covered
medical services incurred in an eligible month, which have not been used to
offset a prior spenddown, are at least equal to the difference between their
income and the protected income level for medically needy medical assistance.
(b) The department shall recognize the following
incurred medical expenses, and currently unpaid, obligated prior medical debts
toward the in and out spenddown:
(1) Medical insurance premiums,
deductibles or co-insurance charges;
(2) Necessary medical
or remedial care that would be covered by medical assistance including when
allowable incurred amounts exceed service limits described in He-W 530.03; and
(3) Necessary medical
or remedial care that is recognized by state law but not covered by medical
assistance described in He-W 530.06(a).
(c) Incurred current medical expenses and
obligated prior medical debts of individuals of a family, as defined in He-W
601.04(c), or family members, as defined in He-W 601.04(f), who reside in the
same living unit as the client or for whom the client is liable, shall be used
to satisfy the spenddown amount.
(d) Prior medical debts shall not be prioritized
or required to be used in sequential order and shall be prorated at the client's
option over several months if the total amount of the debt exceeds the spenddown
amount.
(e) The department shall apply incurred, unpaid
medical expenses and currently obligated medical debts toward the spenddown in
the following order:
(1) Unpaid prior
medical debts and uncovered medical expenses shall be applied on the first day
of the month of the in and out period;
(2) Medical insurance
premiums due during the month shall be applied on the first day of the month in
which they are due; and
(3) Current medical
expenses which are or would be covered by medical assistance shall be applied chronologically
after uncovered expenses and may be applied to the following month if they
remain unpaid on the first day of the following month and have not already been
applied toward a spenddown.
(f) A medical expense or prorated expense
described in (d) above shall be used only once to offset the spenddown.
(g) The client may choose either a one or 6 month
spenddown period when the department determines eligibility for in and out
medically needy medical assistance, subject to the following provisions:
(1) An application for
in and out medically needy medical assistance shall be valid only for a maximum
of 6 consecutive months;
(2) The client shall
be given the spenddown amounts for both a one and 6 month spenddown period on
their notice of decision;
(3) The client shall
not be required to choose either a one or 6 month spenddown until they submit
verification of medical expenses to the department and the case meets all
eligibility criteria; and
(4) Once the client has
elected a one month spenddown period and the case has been opened, they shall
not have a 6 month spenddown period unless they reapply for assistance.
(h) When the client has chosen a one month
spenddown period, the amount by which monthly income exceeds the protected
income level as defined in He-W 601.06(s) shall be the client's spenddown
amount, and the spenddown amount shall be computed separately for each month.
(i) When the client
has chosen a 6 month spenddown period, the spenddown amount shall be equal to 6
times the difference between monthly income and the protected income level.
(j) Reported or known changes in case circumstances
such as, but not limited to, changes in income, household composition, and increases
in the protected income level shall affect the one month spenddown amount as
follows:
(1) Before a case is
opened for a one month period, changes in case circumstances which affect the
spenddown amount shall be used to determine eligibility; and
(2) Once a case is
opened for a one month period, changes in case circumstances shall not affect
the spenddown amount.
(k) Reported or known changes in case
circumstances, such as but not limited to changes in income, household
composition, and increases in the protected income level which affect the 6
month spenddown amount shall be used to determine eligibility as follows:
(1) Before a case is
opened for a 6 month period, all known changes affecting that 6 month period shall
be taken into account prior to opening, and the department shall calculate the
changes for the affected months and establish a new spenddown for the 6 months;
(2) Once a case has
been opened for a 6 month spenddown period and has a change that would increase
the spenddown amount, the department shall take the change into account and
take action to review eligibility by computing a new spenddown amount and, if the
case is ineligible, terminate in and out medically needy medical assistance; and
(3) Once a case has
been opened for a 6 month spenddown period and has a change that would decrease
the spenddown amount, the department shall determine if the decrease affects
the original date of eligibility.
(l) Eligibility for in and out medically needy medical
assistance shall begin on the day of the month in which incurred medical costs
equal or exceed the amount of the spenddown.
(m) The client shall notify the department in
person, in writing, or by telephone when he or she has incurred medical costs
which equal or exceed the amount of the spenddown.
Source.
(See Revision Note #1 at Chapter heading for He-W 600) #5171, eff 6-26-91;
ss by #5508, eff 12-1-92; ss by #6865, eff 10-3-98; ss by #8684, eff 7-21-06;
ss by #10743, eff 12-12-14 (See Revision Note at Part heading for He-W 878)
PARTS He-W 879 –through He-W 881 RESERVED
PART He-W
882 Termination of Medical Assistance
Revision Note:
Document #11169,
effective 8-22-16, readopted with amendments He-W 682.04 titled “Four Month
Extended Medical Assistance Due to Increased Child Support” and renumbered the rule as He-W 882.04 titled “Four Month
Extended Medical Assistance Due to New or Increased Spousal Support.” Document #11169 also readopted with
amendments He-W 682.05 titled “Twelve Month Extended Medical Assistance” and
renumbered the rule as He-W 882.05. The source
note information for He-W 882.04 prior to Document #11169 includes the documents
filed under He-W 682.04, and the source note information for He-W 882.05 prior
to Document #11169 includes the documents filed under He-W 682.05.
Although He-W
682.04 and He-W 682.05 had last been filed under Document #9207, effective
7-19-08, these rules did not expire on 7-19-16 since they were extended
pursuant to RSA 541-A:14-a until replaced by He-W 882.04 and He-W 882.05,
respectively, in Document #11169, effective 8-26-16.
He-W
882-01 through He-W 882.03 – RESERVED
He-W
882.04 Four Month Extended Medical
Assistance Due to New or Increased Spousal Support. Pursuant to 42 CFR 435.115, as amended, and
42 USC 1396u-1(c)(1), medical assistance shall be extended for 4 additional
months when the primary reason for the termination of categorically needy
medical assistance is increased income which was caused in whole or in part by
new or increased spousal support income.
Source.
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91;
ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by
#7328, eff 8-1-00; ss by #9207, eff 7-19-08; ss by #11169, eff 8-26-16 (See
Revision Note at Part heading for He-W 882)
He-W 882.05 Twelve Month Extended Medical Assistance.
(a) Assistance groups
receiving a category of financial assistance to needy families (FANF) financial
assistance, as defined in He-W 601.04(g), shall be eligible to receive up to 12
months of extended medical assistance when termination of FANF financial
assistance was due solely to:
(1) Increased hours of
employment; or
(2) Increased income
from employment.
(b) If one of the
conditions in (a)(1)-(2) above are met, the requirement that the household has
received financial assistance in at least 3 of the last 6 months shall not
apply, pursuant to 42 USC 1396r-6(a)(1)(B).
(c) Good cause for
failure to return a complete quarterly report timely, as required by 42 USC
1396r-6(b)(2)(B), shall be limited to the following circumstances:
(1) Mail delay;
(2) Illness of the
parent or caretaker relative, or other family member; or
(3) Emergencies such
as floods, fires, loss of shelter, or similar events which prevent the family
from returning the quarterly report on time.
Source.
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #6446, eff 2-1-97; amd by
#6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; amd by
#6614, eff 10-24-97; ss by #7328, eff 8-1-00; ss by #9207, eff 7-19-08; ss by
#11169, eff 8-26-16 (See Revision Note at Part heading for He-W 882)
PART He-W 883 RESERVED
He-W 884.01 Redeterminations
- General.
(a) A redetermination of
eligibility shall be required under the following conditions:
(1) At regularly scheduled intervals as prescribed
by federal regulations;
(2) Prior to the expiration of extended medical
assistance coverage periods, if the individual requests a redetermination of
eligibility for benefits;
(3) When requested by the individual;
(4) When the department of health and human services (DHHS) discovers conflicting information regarding eligibility
factors; or
(5) When a change in case circumstances affects
other eligibility factors.
Source.
#13524, eff 1-24-33
He-W 884.02 Regularly
Scheduled Redeterminations.
(a) For modified adjusted gross income (MAGI)
based medical assistance, redeterminations shall be scheduled no more than once
every 12 months.
(b) For non-MAGI based
medical assistance, redeterminations shall be scheduled at least every 12
months.
Source.
#13524, eff 1-24-33
PARTS He-W 885 through He-W 894 RESERVED
PART He-W
895 UNDUE HARDSHIP
Revision Note:
Document #11170,
effective 8-22-16, readopted with amendments Part He-W 695 titled “Undue
Hardship”, which contained He-W 695.01 through He-W 695.08, and renumbered He-W
695 as He-W 895, containing He-W 895.01 through He-W 895.08. The source note information for He-W 895.01
through He-W 895.08 prior to Document #11170 includes the documents filed under
He-W 695.01 through He-W 695.08, respectively.
Although He-W
695 had last been filed under Document #9225, effective 8-1-08, the rules in
He-W 695 did not expire on 8-1-16 since they were extended pursuant to RSA
541-A:14-a until replaced by the rules in He-W 895 in Document #11170,
effective 8-26-16.
He-W
895.01 Purpose. The purpose of these rules is to establish
criteria for:
(a) The determination of undue hardship pursuant
to 42 USC 1396p(b)(3); and
(b) The waiver of the state's claim for recovery
of medical assistance granted against a deceased Medicaid recipient's estate where
estate recovery would result in an undue hardship.
Source.
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91,
EXPIRED: 6-26-97
New.
#7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08;
ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)
He-W
895.02 Definitions.
(a) “Applicant” means the individual who submits
the written request that the department waive its right to recover for medical
assistance provided to the deceased Medicaid recipient.
(b) "Cost effective" means the amount
of public assistance recovered exceeds the total cost to the department of
pursuing the recovery by $500.00 or more.
(c) "Department" means the department
of health and human services.
(d) "Estate" means all assets and
liabilities of a Medicaid recipient subject to the jurisdiction of the probate
court, including but not limited to all property, real or personal, in a
revocable trust as contemplated by RSA 167:14-a, V and property held by the recipient
during his or her lifetime in either joint tenancy, tenancy in common, or life
estate as contemplated at RSA 167:14-a, VI.
(e) "Heir" means those persons, including
the surviving spouse, who might be entitled to some or all of the estate of the
Medicaid recipient under the statutes of succession.
(f) "Income producing property" means real
property, either residential, commercial or industrial upon which money is
made, such as rental property.
(g) "Medicaid recipient" means an
individual who receives or received Medicaid benefits.
(h) “Medical institution” means any nursing
facility as defined at 42 USC §1396r(a), long term care facility for the
mentally retarded as defined at 42 USC §1396d(d), or medical institution as
defined at 42 CFR §435.1010.
(i) “Medical
professional” means any doctor, physician’s assistant, nurse, nurse practitioner,
licensed nursing assistant or certified nursing assistant who regularly
provided treatment to the deceased Medicaid recipient prior to the deceased Medicaid
recipient’s admission to the medical institution.
(j) "Primary residence" means the
applicant’s or heir's domicile.
(k) "Probate court" means the court having
jurisdiction over the administration of estates as provided by RSA 547:3.
(l) “Uncompensated care” means care provided to the
deceased Medicaid recipient gratuitously, without compensation from the
department or any other person, organization, or agency and for which the
applicant has not filed a claim against the estate for reimbursement under any
theory of law or equity.
(m) "Undue hardship" for purposes of
He-W 695, means circumstances described in these rules that would make application
of the department's right to recovery unfair and which, if verified as provided
in these rules, would result in the department's waiving its right to recover
for medical assistance correctly paid on behalf of the deceased Medicaid
recipient.
Source.
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED:
6-26-97
New.
#7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08;
ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)
He-W 895.03 Waiver of Recovery.
(a) The administrator or executor of the estate,
the surviving joint tenant or remainderman of a life estate shall receive
written notice of the right to request a waiver of recovery under these rules,
including criteria for determining undue hardship and the procedure for
requesting such a waiver concurrent with the notification of the department’s claim.
(b) Recovery of medical assistance pursuant to RSA
167:14 shall be waived if recovery will result in undue hardship to the heir as
determined under He-W 895.04 or if the department determines that it is not
cost effective to recover the assistance paid.
Source.
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91,
EXPIRED: 6-26-97
New.
#7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08;
ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)
He-W
895.04 Criteria for Determination of
Undue Hardship. The department shall
waive recovery on the basis of undue hardship as provided in (a), (b), (c),
(d), (e) or (f) below:
(a) Where the estate includes real property on
which a business or farm is located and:
(1) The business or
farm has been in operation at the primary residence of the heir for at least 12
months preceding the death of the decedent;
(2) The business or
farm produces more than 50% of the heir's livelihood; and
(3) The recovery of
the claim would directly result in the loss of the livelihood of the heir;
(b) Where the estate includes income-producing property
and:
(1) The heir has used
his/her own personal resources for the past 12 months to maintain the income-producing
property;
(2) The property
produces more than 50% of the heir's livelihood; and
(3) The recovery of
the claim would directly result in the loss of the livelihood of the heir;
(c) Where the estate includes only personal
property and recovery by the department would directly result in the heir
becoming eligible for public assistance;
(d) Where the estate includes the home of the
Medicaid recipient upon which the department placed a lien or upon which the
department had authority to place a lien but didn’t due to insufficient time,
and:
(1) The applicant is
an adult child of the deceased Medicaid recipient;
(2) The applicant is
the grandchild of a deceased Medicaid recipient who died on or after January 1,
2008 and who can establish that the deceased Medicaid recipient had
guardianship over the applicant while the applicant was a minor or that the
deceased Medicaid recipient served as in-loco parentis to the applicant
while he or she was a minor;
(3) The applicant
resided in the home of the deceased Medicaid recipient for a period of at least
2 years immediately before the date of the deceased Medicaid recipient's admission
to the medical institution;
(4) The applicant
establishes that he or she provided uncompensated care daily to the deceased
Medicaid recipient for at least 2 years immediately before the date of the
deceased Medicaid recipient’s admission to the medical institution which permitted
the deceased Medicaid recipient to reside at home rather than in a medical
institution, including but not limited to any or all of the following activities:
a. Bathing;
b. Dressing;
c. Administering
medication;
d. Shopping;
e. Cooking;
f. Feeding;
g. House cleaning;
h. Money management;
i. Driving; or
j. Other care specific
to the condition of the deceased Medicaid recipient; and
(5) The applicant is lawfully
residing in the home of the deceased Medicaid recipient and has lawfully
resided in such home on a continuous basis since the date of the deceased Medicaid
recipient's admission to the medical institution;
(e) Where the estate includes the home of the
Medicaid recipient, and:
(1) The applicant is a
sibling of the deceased Medicaid recipient;
(2) The applicant
resided in the home of the deceased Medicaid recipient for a period of at least
one year immediately before the date of the deceased Medicaid recipient's admission
to the medical institution; and
(3) The applicant is
lawfully residing in the home of the deceased Medicaid recipient and has lawfully
resided in such home on a continuous basis since the date of the deceased
Medicaid recipient's admission to the medical institution; or
(f) Where the estate includes the home of the Medicaid
recipient which she or he held either in life estate or in joint tenancy, and:
(1) The applicant can
demonstrate that he or she is either the remainderman under the life estate or
the surviving joint tenant; and
(2) The applicant can
demonstrate that he or she paid value for the remainder interest or joint interest
either when the interest was created or to cure a transfer of asset penalty
contemplated at He-W 820.01(s)(3).
Source.
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91,
EXPIRED: 6-26-97
New.
#7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08;
ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)
He-W
895.05 Request for Undue Hardship.
(a) A request for an undue hardship waiver shall
be in writing and include the following information:
(1) The deceased
Medicaid recipient's name;
(2) The deceased
Medicaid recipient's last street address;
(3) The applicant’s
name;
(4) The applicant’s
relationship to the deceased Medicaid recipient; and
(5) The reason(s) for
the undue hardship waiver request as described in He-W 895.04.
(b) Relevant documentation shall be attached to support
the undue hardship waiver request including, but not limited to, the following:
(1) Mortgage note;
(2) Real property
deed;
(3) IRS forms, including
business, personal or farm deduction forms;
(4) Proof of residency
such as a copy of the heir's driver's license or W-2;
(5) Canceled checks
relating to the income producing property or business;
(6) City or town tax
assessor bills;
(7) A copy of the deceased
Medicaid recipients' death certificate;
(8) Estate paperwork
filed with probate court;
(9) An affidavit from
the applicant describing the kind and quality of care provided the deceased
Medicaid recipient including dates the care was provided, if applicable; and
(10) Affidavits from
at least 2 medical professionals who cared for the deceased Medicaid recipient
prior to admission to the medical institution stating that the applicant
provided the kind and quality of care necessary to maintain the Medicaid
recipient at home rather than in a medical institution for at least 2 years immediately
before the Medicaid recipient’s admission to the medical institution.
Source.
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED:
6-26-97
New.
#7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08;
ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)
He-W
895.06 Undue Hardship Request Review.
(a) A request for a hardship waiver shall be filed
with the department within 30 calendar days from the Medicaid recipient's death
or within 30 calendar days from the date of the filing of the department's
claim with the probate court, whichever is later.
(b) The request shall contain a written statement
of the circumstances constituting the hardship and supporting documentation as
described in He-W 895.05.
(c) Determinations of the existence of undue
hardship shall be made within 90 calendar days from the date of the hardship
waiver request.
(d) A written notice of decision shall be sent to
the person making the request.
(e) All denial notices shall include a statement
informing the applicant that he/she may appeal the department's decision and instructions
for how to request an administrative appeal.
Source.
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91,
EXPIRED: 6-26-97
New.
#7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08;
ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)
He-W
895.07 Reduction from Claim Against
Non-Probate Assets.
(a) Surviving joint tenants or remainderman of
life estates shall be eligible for a dollar-for-dollar reduction in the amount
of the department’s claim for medical assistance correctly paid on behalf of a
deceased Medicaid recipient when he or she can demonstrate that he or she
advanced their personal funds to provide for a shortfall in the deceased Medicaid
recipient’s expenses reasonable and necessary for burial as contemplated at RSA
554:19, I(b).
(b) Satisfactory documentation of personal funds
advanced shall be cancelled checks and billing statements from the entity
providing the disposition services such as a funeral home, crematory or
monument company.
(c) No reduction shall be granted for expenses
that are not necessary for burial as contemplated at RSA 554:19, II including
but not limited to flowers, music, post-prandial meals, travel expenses to or
from funeral services, telephone or postage expenses.
Source.
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91,
EXPIRED: 6-26-97
New. #7311, eff 6-22-00; ss by #7667, eff 3-27-02;
ss by #9225, eff 8-1-08; ss by #11170, eff 8-26-16 (See Revision Note at Part heading
for He-W 895)
He-W 895.08 Administrative Hearings.
(a) A decision pursuant to He-W 895.06 shall be
final unless within 30 calendar days of the date of the decision, a request is
submitted for an administrative appeal pursuant to He-C 200.
(b) If the department's administrative appeal
process finds in favor of the applicant, then the department shall withdraw its
claim for recovery from probate court.
Source.
(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91,
EXPIRED: 6-26-97
New.
#7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08;
ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)
PARTS He-W 896 through He-W 898 RESERVED
PART He-W 899 SPECIAL
PAYMENT SITUATIONS
He-W 899.02 Post Office Boxes and General Delivery Mailing
Addresses.
(a)
Notices, letters, or any other correspondence from the department
relative to programs administered by the department shall be mailed to a post
office box or general delivery address only when the client lives in an area
where home delivery of mail is not available, or the area is subject to
extensive mail pilferage.
(b)
The client shall provide verification in writing of the reason for the
request to have mail sent to an address other than the residence address.
(c)
If use of a post office box or general delivery mailing address is not
verified, the department mail described in (a) above shall be mailed to the
residence address.
Source.
#10743, eff 12-12-14
APPENDIX
A: Incorporation by Reference
Information
Rule |
Title |
Publisher;
How to Obtain; and Cost |
He-W 837.04(a)(1) |
ASAM Criteria: Treatment Criteria for Substance-Related,
Addictive, and Co-Occurring Conditions, 3rd edition (2013) |
Publisher: American Society of Addiction Medicine
(ASAM). The ASAM Criteria (2013)
can be purchased online through the ASAM website at: http://www.asamcriteria.org/. Cost = $95 (non-members)
or $85 (members). Discounts are available for large purchases. |
APPENDIX
B
Rule |
Specific State Statute the Rule Implements |
He-W 802.03 |
RSA 161:4-a, IV; RSA 167:3-c,
I; RSA 167:4; RSA 167:8; 42 CFR 435.907 |
He-W 803.01 |
42
CFR 435.908(b), 42 CFR 435.923 |
He-W 803.02 |
RSA
167:17-b, RSA 641:3 |
He-W 803.03 |
RSA
167:17, 42 CFR 435.916(c) |
He-W 804.04 |
RSA
167:3-c,I; RSA 167:83,II(b); 45 CFR 206.10(a)(4) |
He-W 804.05 |
RSA 167:3-c,I;
RSA 167:31; RSA 167: 32; RSA 167:83,II(b); 45 CFR
206.10(a)(4); 42 CFR 431.300-42 CFR 431.307 |
He-W 806.18 |
42
CFR 435.1009, 42 CFR 435.1010 |
He-W 806.37 |
RSA 167:3-c,I; 42 CFR 435.608;
42 CFR 435.914
|
He-W
806.55 |
RSA
167:3-b; RSA 167:3-c,I; RSA 167:79,V(b); RSA 167:80; |
He-W
806.60 |
RSA
161:4-a,II; RSA161:4-a,X(g); RSA 167:3-c,I; RSA 167:7,IV; RSA
167:17,III; RSA 167:17-b,I(a); RSA 167:17-b,I(d); 42 CFR 435.601(b) |
He-W 806.68 |
RSA 167:4,I(a); 42 CFR 435.914
|
He-W 806.69 |
RSA 167:6,VI; 20 CFR 416.905;
20 CFR 416.976; 20 CFR 416.1112(c)(6); 42 CFR 435.914; 42 USC 1382c
|
He-W 806.74 |
RSA
167:4,I(a); 42 CFR 435.733(c)(4)(ii); 42 CFR 435.832(c)(4)(ii) |
He-W 806.78 |
RSA
167:4; RSA 167:7, IV; 42 CFR 435.601(b), 42 CFR 435.914 |
He-W
806.89 |
RSA 161:4-a,X; RSA 167:3-c,I;
42 CFR 435.4; 42 CFR 435.300;
42 CFR 435.301; 42 CFR 435.330; 42 CFR 435.831; 42 USC
1396a(a)(10); 42 USC 1396d(a)
|
He-W
806.92 |
RSA 161:4-a, IX; RSA
167:3-c, I; 42 CFR 435.908 |
He-W 816.02 |
RSA
167:3-c, I; 8 USC 1641(b); 42 USC 602(a)(1)(B)(ii); 42 CFR 435.406
|
He-W 820.01 |
RSA 126-A:4-b,(a); RSA 161:4-a, II; RSA 167:3-c, I; RSA 167:4, I(b), III-a, & IV; 42 USC 1396p(c); 42
USC 1382a
|
He-W 821.01 |
RSA 126-A:4-b,(a); RSA
167:3-c, I; RSA 167:4, III-a & IV; 42 USC 1396p(c)(2)(D)
|
He-W 821.02 |
RSA 126-A:4-b,(a); RSA
167:3-c, I; RSA 167:4, III-a & IV; 42 USC 1396p(f)
|
He-W 821.03 |
RSA 126-A:4-b,(a); RSA
126-A:5, VIII; 42 USC 1396p(c)(2)(D)
|
He-W 824.01 |
42
CFR 435.1009, 42 CFR 435.1010 |
He-W 830.01 |
RSA 169-C:3,XIV; RSA 167:6; RSA 167:78;
RSA 167:79,II & V(b) |
He-W
837.01 |
RSA
126-AA; 42 U.S.C. 12101 et seq.; Pub. L.
No. 93-112; Pub. L. 111-148; 42 CFR
435.916 |
He-W
837.02 |
42
CFR 435.603(a)-(h) |
He-W
837.03 |
RSA
126-AA |
He-W
837.04 |
RSA
126-AA; RSA 167:82,II(g); 42 CFR 435.4; 42 CFR 440.315(f) |
He-W
837.05 |
RSA
126-AA; RSA 167:3-i; RSA 167:6, IV-VI; RSA 167:3-e; RSA 167:3-f; 42
U.S.C.1396a(a)(10)(A)(ii)(XV); 42 CFR 435.4; 42 CFR 435.121; 42 U.S.C.
1396a(e)-(f); 42 U.S.C. 1396n; 42 U.S.C. Chapter 7; 42 U.S.C. 1381 et seq. |
He-W
837.06 |
RSA
126-AA |
He-W
837.07 |
RSA
126-AA; RSA 641:3; RSA 167:82,II(g) |
He-W
837.08 |
RSA
126-AA; 45 CFR 475 |
He-W
837.09 |
RSA
126-AA; 45 CFR 400.75 |
He-W
837.10 |
RSA
126-AA; 42 U.S.C. 12101 et seq. |
He-W
837.11 |
RSA
126-AA |
He-W
837.12 |
RSA
126-AA; 24 CFR 5.2005; 24 CFR 5.2009 |
He-W
837.13 |
RSA
126-AA |
He-W
837.14 |
RSA
126-AA; 24 CFR 5.2005; 24 CFR 5.2009 |
He-W
837.15 |
RSA
126-AA |
He-W
837.16 |
RSA
126-AA; 42 CFR 435.916(f) |
He-W
837.17 |
RSA
126-AA |
He-W
837.18 |
RSA
126-AA |
He-W 841.03 |
RSA
167:3-I; RSA 167:3-c,XII;RSA 167:6,IX; 42 USC 1396a(a)(10)(A)(ii)(XV)
[Section 1902(a)(10)(A)(ii)(XV) of the Social Security Act] |
He-W
844.01 |
RSA 161:4-a, IX; RSA 167:3-c,
I; |
He-W 848.03 |
RSA 167:3-c, II-b; RSA 167:7, I-a; RSA 167:27-c;
42 USC 1382g
|
He-W 852.06 |
RSA 161:4-a, IX; RSA 167:3-c, I |
He-W 852.07 |
RSA 167:3-c, I; RSA 161:4-a, IX; 42 CFR 435.608 |
He-W 854.02 |
RSA 167: 3-c, IX, RSA 167:4, I(a);
RSA 167:6, VII; Section 1902(f) of the Social Security Act (SSA) [42 USC
1396a(f)]; 42 CFR 435.401(c)(2); 42 CFR 435.601(b); |
He-W
854.15 |
RSA
167:3-c, IX, RSA 167:4, I; 20 CFR 416.976, 20 CFR 416.1112 |
He-W 854.16 |
RSA
167:4, I(a) |
He-W 854.17 |
RSA
167:27-a,, 42 CFR 435.733, 42 CFR 435.832, 38 USC 5503, Section 1924(d) of the
SSA [42 USC 1396r-5(d)] |
He-W 854.18 |
RSA 167:3-c, IX ; RSA 167:4,
I(a); Section 1902(a) of the SSA [42 USC 1396a(a)(17)(B),(C)]; 20 CFR
416.1112(c); 42 CFR 435.601(b) |
He-W 854.20 |
RSA
167:4, I(a) |
He-W 856.01 |
RSA 167:4, 42 CFR 435.725(c)(2), 42 CFR 435.832(c)(2),
42 CFR 435.840, 42 USC 1396a(q), Section 1924(c)(1) & (d)-(g) of the SSA
[42 USC 1396r-5(c)(1) & (d)-(g)] |
He-W 856.02 |
RSA 161:4-a, III; 42 USC 604(h); 45 CFR 263.20-23; 45 CFR 260.31(b)(5) |
He-W 856.03 |
RSA 167:3-c,I;
RSA 167:4-a; RSA 167:7,IV; 42 USC 1396p(c)(3); 42 CFR 435.845 |
He-W
856.04 |
RSA 167:3-c,I;
RSA 167:4; RSA 167:17; RSA 167:81; RSA 167:83 II(m)
45 CFR
233.20(a)(3); Section 1612(a)(2)(G) of the Social Security Act (SSA)
[42 USC
1382a(a)(2)(G)]; Section 1613 of the SSA [42 USC 1382b]
Section
1902(a)(10)(A)(ii)(XIII) of the SSA [42 USC 1396a(a)(10(A)(ii)(XIII)]
Section
1917(c)(1)(H)-(I) of the SSA [42 USC 1396p(c)(1)(H)-(I)]
Section 1917(d) of the (SSA) [42 USC 1396p(d)]
|
He-W 856.05 |
RSA 161:4-a, II; RSA 167:3-c, I; 42 CFR 435.210
|
He-W 856.06 |
RSA 167: 4, IV(d); 42 CFR 435.10; 42 CFR 435.210; 42
CFR 435.601; 42 CFR 435.840; 42 CFR 435.843, 42 CFR 435.845
|
He-W 858.04 |
42 USC
1396b(f)(1)(A)-(C); 42 USC 1396u–1(b) |
He-W 858.05 |
RSA 151-E:3; RSA 167:4, I(a); 20
CFR 416.405; 20 CFR 416.410; 42 CFR 435.211; 42 CFR 435.236; 42 CFR 435.622 |
He-W 858.06 |
RSA 151-E:3; RSA 167:4, I(a), 42
CFR 435.217(a); 42 CFR 435.622; 42 CFR 435.831(b)-(c); 42 CFR 435.1005 |
He-W 864.02 |
RSA 167:6, VII; RSA 167:79,
II; 42 CFR 435.310; 42 CFR 435.603(a)(2) & (j)(6); 42 CFR 435.831
|
He-W 876.01 |
RSA
167:6,VII; 42 CFR 435.211; 42 CFR 435.622; 42 CFR 435.831; 42
CFR 435.840 |
He-W
878.01 |
RSA 161:4-a,X; RSA 167:3-c,I; 42 CFR 435.4; 42 CFR 435.300; 42 CFR 435.301; 42 CFR 435.330; 42 CFR 435.831; 42 USC 1396a(a)(10); 42 USC 1396d(a)
|
He-W
882.04 |
42
CFR 435.115(f)-(h); 45 CFR 233.20(a)(15); 42 USC 1396u-1(C)(1) |
He-W
882.05 |
RSA
167:82, VI; 42 USC 1396r-6; 42 USC 1396u-1(c)(2) |
He-W
884.01 |
42
CFR 435.916; RSA 126-A:3,VIII as amended by Chapter 224:43, Laws of NH 2011 |
He-W
884.02 |
42
CFR 435.916; RSA 126-A:3,VIII as amended by Chapter 224:43, Laws of NH 2011;
RSA 167:3-c,VIII; RSA 167:83,II(d) |
He-W
895.01-He-W 895.06 |
RSA
167:13-16; 42 USC 1396p |
He-W
895.07 |
RSA
167:13-16; RSA 554:19; 42 USC 1396p |
He-W
895.08 |
RSA
167:13-16; 42 USC 1396p |
He-W
899.02 |
RSA 167:3-c,I; 45 CFR 205.32
|