N.H. Code Admin. R. He-M 507.06 - Certification

(a) To be eligible for reimbursement by the bureau or by Medicaid for community participation services provided to individuals, community participation services shall be certified by the department.

(b) If a provider agency wishes to furnish community participation services to 3 or more persons who have not been found eligible for area agency services, the provider agency shall be licensed as an adult day program in accordance with RSA 151 and He-P 818.

(c) An entity seeking certification or recertification to provide community participation services shall submit an application to:

Bureau of Health Facilities Administration (BHFA)

Hugh J. Gallen State Office Park

129 Pleasant Street, Brown Building

Concord, NH 03301

(d) Application materials shall include the following:

(1) A completed "Request for Certification of Community Residence and/or Individual Community Participation Services Provider" application (September 2013 edition);

(2) A written description of the proposed staffing pattern necessary to provide services pursuant to He-M 507.04;

(3) The names, titles, qualifications and relevant experience of all staff members, in accordance with He-M 506.03 and He-M 507.10;

(4) Written administrative policies and procedures, which shall comply with He-M 507.08(b) ; and

(5) If the community participation services are provided in a centralized service site, a copy of a life safety report which shall:

a. Have been completed no more than 90 days prior to submission; and

b. Include:

1. The name and address of the provider agency;

2. The date of inspection and certification by the local fire inspector that the centralized service site, if applicable, complies with local fire safety codes;

3. The maximum number of individuals authorized to receive services; and

4. The signature, title, and professional affiliation of the local fire inspector.

(e) For a provider agency requesting initial certification, certification shall be granted for 90 days from the date the department receives all required information if the provider agency meets the requirements of, or demonstrates the capacity to meet the requirements of, He-M 507.04, He-M 507.08(b) , and He-M 507.10.

(f) An initial certification review shall be conducted at the provider agency location by BHFA within 90 days of the effective date of the initial certificate for the purposes of determining whether or not the community participation services are in compliance with these rules.

(g) Initial certification shall be granted from the effective date of the initial certificate until the last day of the twelfth month following certification when the provider agency verifies that:

(1) Any necessary corrective action has been taken; and

(2) The services conform with all applicable rules adopted by the commissioner.

(h) For community participation services that are applying for recertification, BHFA shall conduct a certification review prior to the expiration date of the certificate. The current certification shall be effective until recertification has been granted or denied or unless the current certification is revoked.

(i) A community participation service program applying for recertification shall submit a completed application 60 days prior to the expiration of the certificate.

(j) The renewal period for certificates shall be one year from the expiration date of the previous certificate for:

(1) Community participation service programs certified for 51 or more individuals; and

(2) Community participation service programs certified for 50 or fewer individuals with 3 or more deficiencies.

(k) The renewal period for certificates shall be 2 years from the expiration date of the previous certificate for community participation service programs certified for 50 or fewer individuals with 2 or fewer deficiencies.

(l) When a renewal certificate is issued for a period of 2 years, the provider agency holding the certificate shall conduct a quality assurance review one year following the issuance to ensure that the community participation service program remains in compliance with all applicable rules.

(m) When BHFA staff conduct the 2-year certification review:

(1) If the community participation service program has documentation of a review pursuant to (l) above, BHFA staff shall:

a. Review such documentation;

b. Cite any deficiency noted during the agency-conducted quality assurance review that has not been addressed; and

c. Review the community participation service program's compliance for the previous year; or

(2) If the community participation service program lacks documentation of a review pursuant to (l) above, BHFA staff shall:

a. Cite this as a deficiency; and

b. Hold the entire 2-year period subject to review.

(n) Notwithstanding (m) (1) above, any documentation maintained by a community participation service program during its most recent 2-year certification period shall be open to review by BHFA staff for compliance with applicable department rules.

(o) If deficiencies were cited in the inspection report, within 21 days of the date of issuance of the report the community participation service program shall submit a written plan of correction or submit information demonstrating that the deficiency(ies) did not exist. The department shall evaluate any submitted information on its merits and render a written decision on whether a written plan of correction is necessary.

(p) The department shall, within 45 days:

(1) Accept a plan of correction or other information submitted pursuant to (o) above if:

a. The plan:

1. Addresses each identified deficiency in a manner which achieves full compliance with rules cited in the inspection report;

2. Does not create another violation of statute or rule as the result of its implementation;

3. States a completion date; and

4. Identifies a plan for how each deficiency will be prevented in the future; or

b. The information submitted proves that the deficiency was cited erroneously; or

(2) Reject a plan of correction or other information submitted pursuant to (o) above that fails to meet the criteria in (1) above.

(q) If the proposed plan of correction is rejected, the department shall notify the provider agency in writing of the reason(s) for rejection.

(r) Within 10 business days of the date of the written notice under (q) above, the provider agency shall submit a revised plan of correction that includes proposed alternatives that address the reason(s) for rejection.

(s) The department shall either accept or reject the revised plan in accordance with (p) above. If the revised plan of correction is rejected, the department shall deny the certification request. The provider agency may appeal the denial pursuant to He-M 507.15.

(t) The department shall renew a certificate if it determines that:

(1) No deficiencies exist; or

(2) The plan of correction complies with (p) (1) a. above.

Notes

N.H. Code Admin. R. He-M 507.06

#2269, eff 1-10-83; ss by #2963, eff 1-22-85; ss by #4314, eff 9-27-87; ss by #4659, eff 8-4-89; EXPIRED: 8-4-95

New. #6285, eff 7-12-96, EXPIRED: 7-12-04

New. #8142, INTERIM, eff 8-21-04, EXPIRED: 2-17-05

New. #8324, eff 4-16-05, EXPIRED: 4-16-13

New. #10320, INTERIM, eff 4-25-13, EXPIRES: 10-22-13; ss by #10426, eff 10-1-13 (from He-M 507.03 )