N.H. Admin. Code § He-C 6344.21

Current through Register No. 50, December 12, 2024

Section He-C 6344.21 - Service Limitations Extensions

(a) Medicaid recipients shall be subject to the service limits described in He-W 530.

(b) Non-Medicaid recipients shall be limited to 12 visits per year.

(c) The provider's requests to extend the service limit shall be made in writing 30 days prior to the expiration of benefits.

(d) Written request made pursuant to (c) above shall be submitted to the CPSW and JPPO and include the following:

(1) Provider name, address, telephone number, and medicaid provider number;

(2) Recipient name, address, telephone number;

(3) The type of service being requested;

(4) Initial assessment as described in He-C 6344.20(c) ;

(5) A copy of the providers treatment plan as described in He-C 6344.20(c) ;

(6) Identification of:

a. The progress and measurable outcomes of treatment to date;

b. The prognosis including the likelihood of achieving anticipated outcomes in the future; and

c. The need for any availability of other services; and

(7) The duration of the requested extension.

(e) Extensions shall be time-limited and based on the needs of the child and family.

N.H. Admin. Code § He-C 6344.21

(See Revision Note at part heading for He-C 6344) #9311, eff 11-5-08

Amended by Volume XXXVII Number 28, Filed July 13, 2017, Proposed by #12206, Effective 6/10/2017, Expires 6/10/2027.