N.H. Code Admin. R. He-M 521.13 - Payment

(a) In order to receive funding under He-M 521, services shall be certified by the bureau in accordance with He-M 521.09.

(b) Community-based care providers shall submit claims for covered community-based care services on to:

Xerox Provider Services

ATTN: Claims Administration

P. O. Box 2003

Concord, NH 03302-2003

(c) Payment for community-based care services shall only be made if prior authorization has been obtained from the bureau.

(d) Requests for prior authorization shall be made in writing to:

Xerox Provider Services ATTN: Claims Administration

PO Box 2003

Concord, NH 03302-2003

(e) For those individuals whose net income exceeds the appropriate standard of need, Medicaid claims payment will reflect a reduction in reimbursement equal to the cost of care amount..

(f) In those situations where cost of care is subtracted from the Medicaid billings, the area agency shall recover the cost from individuals unless they qualify for Medicaid for employed adults with disabilities (MEAD) pursuant to He-W 641.03.

(g) Payment for services shall not be available to any service provider who:

(1) Is a person under age 18; or

(2) Is the spouse of an individual receiving services.

Notes

N.H. Code Admin. R. He-M 521.13

#9475, eff 5-22-09

Amended by Volume XXXVII Number 32, Filed August 10, 2017, Proposed by #12340, Effective 7/25/2017, Expires 7/25/2027.