N.H. Code Admin. R. He-E 801.02 - Definitions

Current through Register Vol. 41, No. 39, September 30, 2021

(a) "Activities of daily living (ADLs) " means activities such as grooming, toileting, eating, dressing, getting into or out of a bed or chair, walking, and monitoring and supervision of medications.
(b) "Annual aggregate Medicaid cost" means the total Medicaid costs for nursing facility residents, combining both the initial Medicaid payments and quarterly supplemental payments.
(c) "Average aggregate payment" means the value of the annual aggregate Medicaid cost of nursing facility services divided by the number of paid Medicaid bed days in nursing facilities.
(d) "Bureau" means the department's bureau of elderly and adult services (BEAS) .
(e) "Care plan" means a written guide that:
(1) Is developed and maintained by the service provider in consultation with the participant, his or her legal representative, if any, or both;
(2) Is developed as a result of an assessment process which includes communication with the participant's case manager;
(3) Is consistent with and addresses the applicable service needs identified in the participant's comprehensive care plan; and
(4) Contains specific instructions on providing a defined service to the participant.
(f) "Case management agency" means an agency that is enrolled as a New Hampshire Medicaid provider to provide targeted case management services to CFI participants in accordance with He-E 805.
(g) "Case manager" means a person providing services in accordance with He-E 805, who has the primary responsibility for assessing the participant's needs, developing a comprehensive care plan, and coordinating and monitoring the services described in the comprehensive care plan.
(h) "Choices for Independence (CFI) " means a system of long-term care services provided under Section 1915(c) of the Social Security Act to participants who meet the eligibility requirements in He-E 801. This term is also known as home and community-based care for the elderly and chronically ill (HCBC-ECI) .
(i) "Commissioner" means the commissioner of the New Hampshire department of health and human services, or his or her designee.
(j) "Comprehensive care plan" means an individualized plan described in He-E 805.05(c) that is the result of a person-centered process that identifies the strengths, capacities, preferences, and desired outcomes of the participant.
(k) "Department" means the New Hampshire department of health and human services.
(l) "Home-based services" means long term care services provided to an individual either in a private home setting or in a mid-level residential facility, including:
(1) CFI services;
(2) Case management services; and
(3) The following Medicaid State Plan services:
a. Personal care attendant;
b. Home health aide;
c. Home health nursing;
d. Physical therapy;
e. Occupational therapy;
f. Speech therapy;
g. Adult medical day; and
h. Private duty nursing.
(m) "Legal representative" means one of the following individuals, duly appointed or designated in the manner required by law to act on behalf of another individual, and who is acting within the scope of his or her authority:
(1) An attorney;
(2) A guardian or conservator;
(3) An agent acting under a power of attorney;
(4) An authorized representative acting on behalf of an applicant in some or all of the aspects of initial and continuing eligibility in accordance with He-W 603.01; or
(5) A representative acting on behalf of another individual pursuant to RSA 161-I, Personal Care Services.
(n) "Legally responsible relative" means "legally responsible relative" as defined in RSA 161-:2, VI. In this rule, the only applicable legally responsible relative is the participant's spouse.
(o) "Licensed practitioner" means:
(1) Medical doctor;
(2) Physician's assistant;
(3) Advanced practice registered nurse;
(4) Doctor of osteopathy;
(5) Doctor of naturopathic medicine; or
(6) Anyone else with diagnostic and prescriptive powers licensed by the appropriate New Hampshire licensing board.
(p) "Medicaid bed days" means the total unduplicated number of days of nursing facility care that were paid for by the Medicaid program in a 12 month period.
(q) "Other qualified agencies" means those entities certified in accordance with RSA 161-I and He-P 601.
(r) "Person-centered planning" means a planning process to develop an individual comprehensive care plan that is directed by the participant, his or her representative, or both, and which identifies his or her preferences, strengths, capacities, needs, and desired outcomes or goals.

Notes

N.H. Code Admin. R. He-E 801.02

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11

Amended by Volume XXXIX Number 32, Filed August 8, 2019, Proposed by #12830, Effective 8/7/2019, Expires 2/3/2020.

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