N.H. Code Admin. R. He-E 801.07 - Redetermination of Eligibility and Service Authorization

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

(a) The eligibility of each participant, as determined in accordance with He-E 801.04, shall be subject to redetermination at least annually.
(b) The redetermination shall be conducted in accordance with He-E 801.04, except that (e) (2) c.2. below shall apply.
(c) The annual redetermination required in (a) above shall not preclude earlier redetermination or reevaluation and subsequent changes to the identified needs list or service authorizations.
(d) Upon a redetermination of eligibility, the identified needs list and service authorizations shall be updated as necessary by the department.
(e) If a participant is determined ineligible, or if services are identified as no longer being clinically necessary, the department shall either terminate CFI eligibility or reduce or terminate the services authorized, respectively, as follows:
(1) Payment for services shall be terminated 30 calendar days from the date of the notice described in (2) below, unless an appeal has been filed within 15 calendar days of the date of the notice; and
(2) A written notice of eligibility termination or the reduction or termination of the services authorized, as applicable, shall be sent to the participant, or his or her legal representative, and the participant's case manager, including:
a. The reason and legal basis for the termination or reduction;
b. The date that service coverage shall be terminated or reduced, absent the filing of an appeal; and
c. Information concerning the participant's right to appeal pursuant to He-C 200, as follows:
1. The participant shall have 30 calendar days to file an appeal, otherwise the department's decision shall be final; and
2. If the participant files an appeal within 15 calendar days of the date of the notice of service coverage termination or reduction, continued payments for CFI services shall be authorized until 30 calendar days after a hearing decision has been made.


N.H. Code Admin. R. He-E 801.07

(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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