Section He-M 525.12 - Funding and Payment(a) Area agencies shall submit to the bureau a proposed individualized budget for each individual requesting initial provision of services under He-M 525, which contains detailed line item information regarding all services to be provided.(b) The bureau shall review the proposed budget and issue a response within 10 business days from the date of request.(c) For each request an area agency makes for funding individual services under He-M 525, the bureau shall make the final determination on the cost effectiveness of the budget and proposed services.(d) Based on an approved individualized budget, service agreement and, if applicable, certification issued pursuant to He-M 525.07(c) , the area agency shall request a prior authorization from the bureau.(e) Requests for prior authorization shall be made in writing to: Bureau of Developmental Services
Hugh J. Gallen State Office Park
105 Pleasant Street
Concord, NH 03301
(f) Once an area agency obtains a prior authorization from the bureau it shall submit claims for Medicaid waiver PDMS to: Conduent
2 Pillsbury Street, Suite 200
Concord, NH 03301
(g) Payment for medicaid waiver PDMS shall only be made if prior authorization has been obtained from the bureau.(h) For those individuals whose net income exceeds the nursing facility cap as established in He-W 658.05, area agencies shall subtract the cost of care from the medicaid billings for the individuals unless they qualify for medicaid for employed adults with disabilities (MEAD) pursuant to He-W 641.03.(i) In those situations where cost of care is subtracted from the medicaid billings, the area agency shall recover the cost from individuals.(j) Payment for PDMS shall not be available to any service provider who: (1) Is the parent of the individual under age 18;(2) Is a person under age 18 if the individual is 21 years or older; or(3) Is the spouse of an individual receiving services.N.H. Admin. Code § He-M 525.12
#9391, eff 2-21-09; ss by #9890-A, eff 3-22-11
Amended by Volume XXXIX Number 37, Filed September 12, 2019, Proposed by #12859, Effective 8/28/2019, Expires 8/28/2029.