Section He-C 6420.04 - Covered Services(a) Medicaid covered services shall be provided to children as part of the residential component of a residential treatment program or foster care program and shall not be billed to the Medicaid to schools program pursuant to He-M 1301.(b) Covered services shall be approved by the prescribing practitioner to be medically necessary, using the following criteria: (1) The services are designed to provide maximum reduction of physical, intellectual, or behavioral disability and restore a child to his or her best possible functional level; and(2) There is no other equally effective course of treatment available on a fee-for-service basis that is more conservative, less restrictive, or substantially less costly than the per diem rate for residential treatment program or foster care program services.(c) Covered services shall:(1) Be provided in accordance with a child's treatment plan; and(2) Be designed to meet the health and rehabilitative needs of a child to address his or her physical, intellectual, or behavioral disability.(d) Covered services shall include: (2) Occupational therapy, including evaluations, treatments or consultations necessary to implement a program of activities to develop or maintain skills necessary to achieve adequate and appropriate physical and mental functioning of a child;(3) Physical therapy, when provided by or under the supervision of a physical therapist, and for which there shall be a physician's written authorization for individual or group treatment, supplies, and equipment related to physical therapy;(4) Psychiatric services when necessary for the evaluation, diagnosis, and treatment of psychiatric problems;(5) Psychological services when necessary for the evaluation, diagnosis, and treatment of emotional or behavioral problems or disturbances;(6) Speech, language and hearing services when necessary for the evaluation, diagnosis, and treatment of speech, language, and hearing disorders;(7) Rehabilitative services, which shall be included in the treatment plan and based on a physician's written referral or a recommendation from a prescribing practitioner;(8) Behavioral health, other than psychiatric and psychological services referenced in (4) and (5) above; and(9) Any other remedial services as are necessary for the maximum reduction of a child's physical, intellectual, or behavioral disabilities, excluding classroom instruction and academic tutoring.(e) Nursing services referenced in (d) (1) above shall be performed by an RN, LPN or ARNP, and shall include:(1) Any evaluations, treatments, staff training, or consultations that are necessary for the child to be safely cared for;(2) Administration of medication;(3) Observation of children with chronic or acute illnesses in order to assure that medical needs are being appropriately identified, addressed and monitored; and(4) Other services allowed under their individual identified scope of practice for nursing services.(f) Physical therapy services referenced in (d) (3) above shall include: (3) Consultation that might prevent, restore or alleviate a loss of or impairment of a physical function.(g) Rehabilitative services referenced in (d) (7) above shall include: (1) Assistance with communication;(3) Nutrition counseling;(4) Medication management and training;(5) Hygiene and personal care training;(6) Coordination of medical care; and(7) Development and implementation of individual treatment plans.(h) Behavioral health services referenced in (d) (8) above shall include, at a minimum: (2) Individual, group, and/or family counseling;(3) Substance use disorder counseling; and(4) Crisis intervention and stabilization.N.H. Admin. Code § He-C 6420.04
Amended by Volume XXXV Number 49, Filed December 10, 2015, Proposed by #10986, Effective 11/26/2015, Expires11/26/2025.