N.H. Code Admin. R. He-E 801.06 - Service Authorization

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

(a) Upon review of the information provided in He-E 801.05(b) , the department shall authorize services that are consistent with services that meet the needs identified in the clinical assessment in He-E 801.04(a) and other verified long-term care needs not previously identified through the assessment.
(b) Service authorizations shall consist of specific types, units, and frequencies of medical and other services.
(c) Service authorizations shall be issued to specific service providers identified by the participant's case manager as a result of person centered planning.
(d) When the service authorization does not include all the services requested, the applicant or participant shall be sent a notice, including:
(1) The requested service;
(2) The authorized service;
(3) A statement regarding the reason and legal basis for the denial; and
(4) Information concerning the applicant's right of appeal pursuant to He-C 200, including the requirement that the applicant has 30 calendar days from the date of the notice authorizing services to file such an appeal.
(e) An applicant or participant who disagrees with a service authorization may request a reconsideration of the service authorization, as follows:
(1) The applicant or participant, or his or her representative, shall submit a written request to the bureau within 30 days of the service authorization; and
(2) The written request shall include an explanation of the reason why a specific service authorization should be changed, including any supporting documentation.
(f) The department shall review the request in (e) above and provide a written notice to the applicant or participant, or his or her representative, of its decision to maintain or change the original service authorization, including the reason therefor.
(g) Requesting a service authorization reconsideration shall not:
(1) Preclude in any way an applicant's or participant's right to appeal a disputed service authorization in accordance with He-C 200; and
(2) Change the timeframes established for filing an appeal.


N.H. Code Admin. R. He-E 801.06

(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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