N.H. Admin. Code § He-M 517.05

Current through Register No. 45, November 7, 2024

Section He-M 517.05 - Covered Services

(a) All services provided in accordance with the home and community-based care waiver shall be specifically tailored to, and provided in accordance with, the individual's needs, interests, competencies, and lifestyle as described in the individual's service agreement.

(b) Services provided pursuant to He-M 517 shall be designed to maintain and enhance each individual's natural supports.

(c) The services identified in (d) -(n) below shall be fundable in accordance with the home and community-based care waiver if such services are identified within an individual's service agreement or IFSP.

(d) Service coordination services shall:

(1) Be provided pursuant to He-M 503.09 - He-M 503.11 or He-M 522.10 - He-M 522.12;

(2) Include the following:

a. Monthly contacts, at a minimum, with the individual or other people who support or serve the individual, unless more frequent contacts are indicated by the service agreement;

b. Quarterly visits with the individual at the individual's residence or site of service, except when a different frequency is required subsequent to provision of participant directed and managed services pursuant to (n) below;

c. Quarterly determination of the individual's satisfaction with services through contact with the individual and his or her:

1. Family;

2. Guardian;

3. Friends; or

4. Service providers, as applicable to the individual's services;

d. Coordination and facilitation of all supports and services delineated in the service agreement;

e. Development and revision of the service agreement;

f. Monitoring, ongoing review and follow-up of all service agreement services; and

g. Referral to the bureau for the assessment of the individual's continued need for waivered services pursuant to He-M 517.08; and

(3) Be reimbursed at a monthly rate.

(e) Personal care services shall:

(1) Be provided pursuant to He-M 1001.05, He-M 525.05, or He-M 521.03, as applicable;

(2) Consist of assistance, excluding room and board, provided to individuals to improve or maintain their skills in basic daily living, community integration, and personal development, as delineated in the service agreement; and

(3) Be reimbursed at a daily rate.

(f) Community participation services shall:

(1) Be provided in accordance with He-M 507.04;

(2) Include the following as required by the individual's service agreement:

a. Instruction and assistance to learn, improve, or maintain:

1. Social and safety skills in different community settings;

2. Decision-making regarding choice of and participation in community activities;

3. Life skills as applied to community-based activities, such as purchasing items and managing personal funds;

4. Good nutrition and healthy lifestyle;

5. Self-advocacy and rights and responsibilities as citizens; and

6. Any other skill identified by the individual or guardian during service planning and related to the individual's participation in, or contribution to, his or her community;

b. Supports to identify and develop the individual's interests and capacities related to securing employment opportunities, including internships;

c. Services related to job development and on-the-job training;

d. Assistance in finding and maintaining volunteer positions;

e. Supports related to enabling the individual to explore, and participate in, a wide variety of community activities and experiences in settings that are available to the general public;

f. Consultation services as specified in the service agreement to improve or maintain the individual's communication, mobility, and physical and psychological health and well-being; and

g. Transportation related to community participation services, including travel from the individual's residence to locations where the community participation service activities are taking place;

(3) Exclude employment or volunteer positions where the individual is:

a. Being solely supported by persons who are not providers; and

b. Not receiving any services from a provider agency at those locations; and

(4) Be reimbursed at a quarter hour rate.

(g) Employment services shall:

(1) Be provided in accordance with He-M 518;

(2) Be available to any individual who:

a. Has an employment goal; and

b. Is not authorized and funded by the NH department' of education's bureau of vocational rehabilitation for the same supported employment service;

(3) Consist of assistance provided to individuals to:

a. Improve or maintain their skills in employment activities; or

b. Enhance their social and personal development or well-being within the context of vocational goals;

(4) Include referral, evaluation, and consultation for adaptive equipment, environmental modifications, communications technology or other forms of assistive technology, and educational opportunities related to the individual's employment services and goals;

(5) When combined with another employment service, transportation and training in accessing transportation, as appropriate, to and from work; and

(6) Be reimbursed at a quarter hour rate.

(h) Respite care services shall:

(1) Be provided pursuant to He-M 513.04 or He-M 513.05;

(2) Consist of the provision of short-term assistance, in or out of an individual's home, for the temporary relief and support of the family with whom the individual lives; and

(3) Be reimbursed at a quarter hour rate.

(i) Environmental accessibility modifications shall:

(1) Include modifications or adaptations to the individual's home environment:

a. To ensure his or her health and safety;

b. That are required by the individual's service agreement; and

c. That are needed to accommodate the medical equipment and supplies that are necessary for the welfare of the individual;

(2) Include modifications or adaptations to the vehicle used by the individual in order to enable him or her to:

a. Travel in greater safety;

b. Access the community; and

c. Carry out activities of daily living; and

(3) Comply with applicable state and local building and vehicle codes.

(j) Crisis response services shall:

(1) Consist of direct consultation, clinical evaluation or support to an individual who is experiencing a behavioral, emotional, or medical crisis in order to reduce the likelihood of harm to the person or others and to assist the individual to return to his or her pre-crisis status;

(2) Include training and staff development related to the needs of the individual;

(3) Include on-call staff for the direct support of the individual in crisis;

(4) Be authorized for a period of up to 6 months; and

(5) Be reimbursed at a quarter hour rate.

(k) Community support services shall:

(1) Be available for an individual who has developed, or is trying to develop, skills to live independently within the community;

(2) Consist of assistance, excluding room and board, provided to an individual to:

a. Improve or maintain his or her skills in basic daily living and community integration; and

b. Enhance his or her personal development and well-being; and

(3) Be reimbursed at a quarter hour rate.

(l) Assistive technology support services shall:

(1) Consist of evaluation, consultation, or education in the use, selection, lease, or acquisition of assistive technology devices, as well as designing, fitting, and customizing of devices;

(2) Not cover the actual cost of assistive technology devices; and

(3) Be reimbursed at quarter hour rates.

(m) Specialty services shall:

(1) Be available to individuals whose medical, behavioral, therapeutic, health or personal needs require services that are particularly designed to address the unique conditions and aspects of their developmental disabilities or acquired brain disorders;

(2) Consist of one or more of the following:

a. Assessment;

b. Consultation;

c. Design, development and provision of services;

d. Training and supervision of staff and providers; and

e. Evaluation of service outcomes;

(3) Include documentation indicating the nature of the service, date, and number of units; and

(4) Be reimbursed at a quarter hour rate.

(n) Participant directed and managed services shall:

(1) Be provided pursuant to He-M 525;

(2) Be available for individuals and their families in order to improve or maintain each individual's health and his or her experiences and opportunities in work and community life;

(3) Consist of assistance and resources within a flexible process that allows the family and individual to control, to the extent desired, the service provision, including, for each service:

a. The type;

b. The amount;

c. The location;

d. The duration; and

e. The service provider;

(4) Be based on a written proposal that includes:

a. A description of the services to be provided that also specifies the expenditures to be made;

b. A line-item budget; and

c. A process for measuring the individual's degree of satisfaction with the services provided;

(5) Not be provided by the spouse of an individual or the parent of an individual where the individual is a minor child;

(6) Be provided by persons qualified pursuant to He-M 506.03 in cases where services are provided by relatives other than parents or by friends; and

(7) Be reimbursed monthly for services provided.

N.H. Admin. Code § He-M 517.05

#4315, eff 9-25-87; EXPIRED: 9-25-93

New. #6360, eff 10-23-96, EXPIRED: 10-23-04

New. #8195, INTERIM, eff 10-29-04, EXPIRED: 4-27-05

New. #8424, eff 9-1-05; amd by #9370, eff 1-24-09; ss by #10454, eff 10-31-13