N.H. Code Admin. R. He-M 520.02 - Application Procedure

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

(a) Except for applicants under (i) below, and in order to be determined eligible to receive program services or financial assistance, a signed, dated, and completed application, entitled "Special Medical Services (SMS) - Application for All Services," (November 2012) shall be submitted to SMS for each applicant.
(b) The following documentation shall accompany the submitted application in (a) above:
(1) Supporting documentation of income and resources, as applicable;
(2) Supporting documentation regarding the applicant's health diagnosis;
(3) A signed release of personal health information, which complies with current Health Insurance Portability and Accountability Act (HIPPA) policies as defined in 45 CFR 160.103 and 45 CFR 164.501; and
(4) Documentation of guardianship of an applicant or foster parent status, as applicable.
(c) Within 60 days of the date of application, SMS shall:
(1) Accept and review all applications for program or financial eligibility, in accordance with He-M 520.03 and 520.05; and
(2) Notify the applicant in writing of the applicant's eligibility status and the services for which the applicant is eligible.
(d) SMS's notice of decision shall include:
(1) For eligibility approvals:
a.The beginning and ending dates of SMS eligibility;
b.The approved SMS services;
c.The name and phone number of an SMS contact person;
d.Financial eligibility determination, including the spend down amount, as applicable; and
e.Notice that the recipient shall report to SMS any change in the recipient's medical insurance coverage, including Medicaid or TPL changes, within 30 days of the change; and
(2) For eligibility denials:
a.The reason(s) for denial;
b.Information about the applicant's right to an appeal in accordance with He-M 202 and He-C 200; and
c.Alternate support services information as available.
(e) For an applicant who is determined to be eligible, eligibility shall be effective for 12 months from the applicant's application date, except when any household changes affect the recipient's eligibility status.
(f) SMS shall notify a recipient in writing 30 calendar days prior to the date that eligibility will close, for such reasons as the 12 month eligibility period is expiring, the recipient is turning 21, services provided are no longer available, or there is a household change which affects eligibility status.
(g) A new application shall be submitted in accordance with (a) and (b) above prior to the expiration of current eligibility.
(h) An applicant or recipient shall have the right to reapply at any time after eligibility has been denied.
(i) For those applicants applying for services through an SMS sponsored child development clinic, the following shall apply:
(1) The requirements in (a) - (j) above shall not apply;
(2) A completed "SMS Short Application" (July 2012) shall be submitted to SMS;
(3) A signed release of personal health information, which complies with current Health Insurance Portability and Accountability Act (HIPPA) policies as defined in 45 CFR 160.103 and 45 CFR 164.501, shall be submitted to SMS;
(4) Eligibility shall be effective for 12 months after the application is submitted; and
(5) To maintain eligibility, another application shall be submitted to SMS.
(j) An applicant who submits false or misleading information shall be subject to the provisions of RSA 132:15 and RSA 638:15.


N.H. Code Admin. R. He-M 520.02

#9748-A, eff 7-1-10, para (c)-(h), intro., & (i)(1), (4), & (5), and (j); #9748-B, eff 7-1-10, paras (a), (b), and (i)(3); amd by #10138, eff 7-1-12

Amended by Volume XXXVIII Number 28, Filed July 12, 2018, Proposed by #12557, Effective 6/26/2018, Expires 12/24/2018.
The amended version of this section by New Hampshire Register Volume 39, Number 02, eff.12/28/2018 is not yet available.

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