N.H. Code Admin. R. He-E 801.10 - Commissioner Prior Approval Process

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

(a) In accordance with RSA 151-E:11, II, no applicant or participant whose home-based services costs would be in excess of 80% of the average annual cost for the provision of services to a person in a nursing facility shall be approved for CFI participation without the prior approval of the commissioner.
(b) The commissioner's prior approval process shall include the following:
(1) A review of the costs of the home-based services identified to meet the applicant's or the participant's needs;
(2) A review of the costs of nursing facility services at a nursing facility qualified to provide services, including any specialized services, that would be necessary for the proper care and treatment of the applicant or participant;
(3) A comparison of the amounts in (1) and (2) above; and
(4) The approval of those cases which do not exceed the individual cost limit specified in the HCBC-CFI waiver approved by the Centers for Medicare and Medicaid Services.
(c) If the commissioner approves the applicant's or the participant's participation in the CFI program, the bureau shall:
(1) Inform the applicant or participant in writing that services through the CFI program shall be provided or continued; and
(2) Inform the applicant or participant in writing that if the approval for services is discontinued in the future due to a determination that the services exceed what is allowed in RSA 151-E:11, the participant shall be informed in writing of the decision and the right to appeal the decision in accordance with He-E 801.04(f) .
(d) If the commissioner does not approve the applicant's or the participant's participation in the CFI program, the bureau shall:
(1) Inform the applicant or participant in writing that services through the CFI program shall not be provided or continued, including the reason and legal basis for the determination; and
(2) Inform the applicant or participant in writing of the right to appeal the decision and the process to file an appeal in accordance with He-E 801.04(f) or 801.07(e) .

Notes

N.H. Code Admin. R. He-E 801.10

(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.

The following state regulations pages link to this page.



State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.