Section He-E 801.02 - Definitions(a) "Activities of daily living (ADLs)" means the primary activities necessary to carry out daily self-care activities that include but are not limited to eating, toileting, transferring, bathing, dressing, and continence.(b) "Adult day services" means one or more of the services delivered by a facility licensed in accordance with He-P 818 and listed in He-E 801.16, provided for fewer than 12 hours a day. This term includes "adult medical day services".(c) "Adult family care (AFC)" means participant housing option for eligible participants under the CFI waiver program, which includes a combination of personal care, homemaking, and other services that are provided to a participant who is a resident in a certified residence of an unrelated individual or the CFI waiver participant's relative in accordance with a person-centered plan.(d) "Annual aggregate medicaid cost" means the total medicaid costs for nursing home residents, combining both the initial medicaid payments and quarterly supplemental payments.(e) "Appeal" means a request to review a decision or action made by the department which adversely affected the individual pursuant to RSA 126-A:5, VIII.(f) "Average aggregate payment" means the value of the annual aggregate medicaid cost of nursing facility services divided by the number of paid medicaid bed days in nursing facilities.(g) "Authorized representative" means "authorized representative" pursuant to He-W 803.01.(h) "Provider care plan" means a written guide that:(1) Is developed and maintained by the service provider in consultation with the participant, his or her legal representative, if any, or both, and the participant's primary care provider, if applicable;(2) Is developed as a result of an assessment process which includes communication with the participant's case manager;(3) Is consistent with and addresses the applicable service needs identified in the participant's comprehensive care plan; and(4) Contains specific instructions on providing a defined service to the participant.(i) "Case management agency" means an agency licensed under He-P 819 and enrolled as a New Hampshire medicaid provider to provide targeted case management services to CFI participants in accordance with He-E 805.(j) "Case manager" means an individual employed by, or contracted with, a case management agency who: (1) Meets the qualifications described in He-E 805.06;(2) Is responsible for the ongoing assessment, person-centered planning, coordination, and monitoring of the provision of services included in the comprehensive care plan; and(3) Does not have a conflict of interest.(k) "Choices for Independence (CFI) waiver program" means a system of long-term services and supports (LTSS) provided under Section 1915(c) of the Social Security Act to participants who meet the eligibility requirements in He-E 801.03 and He-E 801.04.(l) "Commissioner" means the commissioner of the New Hampshire department of health and human services, or his or her designee.(m) "Community transition services" means non-recurring services, including case management services to support CFI participants who are transitioning from an institutional setting or another provider-operated living arrangement to a living arrangement in a private residence, in which the participant is directly responsible for his or her own living expenses in accordance with He-E 801.17.(n) "Comprehensive care plan" means an individualized person-centered plan described in He-E 805.05(c) that is: (1) The result of a person-centered process that identifies the strengths, capacities, preferences, and desired outcomes of the participant;(2) Developed by the participant's case manager; and(3) Is an integrated plan of all the participant's services.(o) "Conflict of interest" means a conflict between the private interests and the official or professional responsibilities of a person, entity, agency, or organization, such as providing other direct services to the participant, being the guardian of the participant, or having a familial or financial relationship with the participant.(p) "Congregate meals" means the provision of meals to groups of participants in a community setting.(q) "Department" means the New Hampshire department of health and human services.(r) "Environmental accessibility services (EAS)" means the installation of ramps, grab bars, widening of doorways, electronic aids to daily living, and other adaptations as authorized by the department, in a participant's home or vehicle as necessary to support the participants' health and safety.(s) "Fading plan" means a specific plan that is developed to assist an individual to achieve maximum independence on the job through a variety of activities including cultivating natural supports.(t) "Financial management services (FMS)" means assisting participants that elect to receive PDMS with the following: (1) Management and disbursement of funds contained in the participant-directed budget;(2) Performing fiscal accounting, and budget management;(3) Creating expenditure reports;(4) Facilitating the employment of staff, and furnishing orientation; and(5) Conducting skills training to participants who function as the co-employer of their direct support workers.(u) "Home-based services" means long-term services and supports provided to a participant either in a private home setting or in a mid-level residential facility, including:(1) CFI waiver services pursuant to this part; and(2) The following medicaid state plan services: a. Targeted case management services pursuant to He-E 805;b. Personal care attendant;h. Adult medical day; and(v) "Home-delivered meals" means prepared meals that are provided to a participant in his or her home.(w) "Home health aide services" means services provided by a nursing assistant licensed in accordance with RSA 326-B.(x) "Homemaker services" means non-hands-on services to support a participant's household management, including light housecleaning tasks, laundry, preparation of meals and snacks, and errands.(y) "In-home care" means nonmedical non-hands on care, supervision, and socialization provided to isolated participants to prevent institutionalization. This term includes "adult in-home care".(z) "Instrumental Activities of Daily Living" (IADL) means basic tasks that are essential to the ability to live independently, such as light housework, laundry, meal preparation, transportation, grocery shopping, using the telephone, medication management, and money management. IADL also includes other supportive activities as specified in the comprehensive care plan which promote and support health, wellness, dignity, and autonomy within a community setting.(aa) "Job carving" means the act of analyzing work duties performed in a given job and identifying specific tasks that may be assigned to an employee with disabilities.(ab) "Legal representative" means one of the following individuals, duly appointed or designated in the manner required by law to act on behalf of another individual, and who is acting within the scope of his or her authority:(2) A guardian or conservator;(3) An agent acting under a power of attorney;(4) An authorized representative acting on behalf of an applicant in some or all of the aspects of initial and continuing eligibility in accordance with He-W 803.01; or(5) A representative acting on behalf of another individual pursuant to RSA 161-I, Personal Care Services.(ac) "Legally responsible relative" means the participant's spouse.(ad) "Licensed practitioner" means: (3) Advanced practice registered nurse;(4) Doctor of osteopathy;(5) Doctor of naturopathic medicine;(7) Occupational therapist; or(8) Anyone with diagnostic and prescriptive powers licensed by the appropriate New Hampshire licensing board.(ae) "Medicaid bed days" means the total unduplicated number of days of nursing facility care that were paid for by the medicaid program in a 12 month period.(af) "Non-medical transportation" means transportation provided to enable participants to access the community when personal care services are required to do so as articulated in the comprehensive care plan.(ag) "Nursing facility" means nursing facility licensed pursuant to RSA 151 that provides for 2 or more persons' basic domiciliary services, including board, room and laundry, continuing health supervision under competent professional medical and nursing direction, and continuous nursing care as may be individually required.(ah) "Other qualified agencies" means those entities certified in accordance with RSA 161-I and He-P 601.(ai) "Participant-directed and managed services (PDMS)" means services that allow CFI waiver participants to direct and manage a menu of any CFI waiver service, except for residential care facility services in accordance with He-E 801.24. PDMS allows the participant to design the services that will be provided, select service providers, decide how authorized funding is to be spent base on the needs identified in the participant's comprehensive care plan, and perform ongoing oversight of the services provided.(aj) "Person-centered planning" means a planning process to develop an individual support plan that is directed by the participant, his or her representative, or both, and which identifies his or her preferences, strengths, capacities, needs, and desired outcomes or goals.(ak) "Personal care services (PCS)" means hands-on assistance with ADLs and IADLs, assisting with self-administration of oral and topical medications, performing light housekeeping, providing cueing with eating or dressing, and accompanying a participant into the community when the assistance of the personal care worker is required by the participant, as provided by staff employed by an agency licensed under He-P 809, He-P 822, or an agency certified under He-P 601.(al) "Personal emergency response system" means an electronic device that enables participants at high risk of institutionalization and who are alone for periods of time to summon help in an emergency 24-hours per day 7 days per week. It also includes a portable help button to allow for the participant's mobility.(am) "Residential care facility" means an assisted living residence-residential care or assisted living-supported residential health care facility licensed in accordance with RSA 151.(an) "Skilled professional medical personnel" means "skilled professional medical personnel" as defined in RSA 151-E:3.(ao) "Skilled nursing services" means services listed in the comprehensive plan of care who are within the scope of RSA 326-B and are provided by a registered professional nurse, or licensed practical nurse that are within the scope of RSA 326-B.(ap) "Specialized medical equipment" means the following: (1) Devices, controls, or appliances that are specified in the comprehensive care plan which enable a participant to increase his or her ability to perform ADLs or IADLs;(2) Devices, controls, or appliances that are specified in the comprehensive care plan to perceive, control, or communicate with the environment in which the participant lives;(3) Items necessary for life support or to address physical conditions along with ancillary supplies and equipment necessary to the proper functioning of such items;(4) Other durable and non-durable medical equipment not available under the New Hampshire Medicaid state plan that are necessary to address participant functional limitations; and(5) Necessary medical supplies not available under the New Hampshire medicaid state plan.(aq) "Supported employment services (SEP)" means individual employment services that help a participant who, because of his or her disabilities, require intensive on-going supports to obtain and maintain competitive employment customized employment or self-employment in an integrated work setting, and includes the following: (1) Vocational or job-related discovery or assessment and job skill trainings necessary to assist with integration in a job setting;(3) Job development and negotiation with prospective employers;(4) Job incentives planning and management;(5) Transportation to employment; and(6) Asset development and career advancement services.(ar) "Supportive housing services" means services provided by a public housing authority licensed as a home health care provider or by a home health care provider contracted with a public housing authority to provide services in apartments located in publicly funded apartment buildings that include the following: (1) Personal care services, including assistance with ADLs and IADLs;(3) Medication reminders; and(4) Other supportive activities as specified in the comprehensive care plan or which promote and support health and wellness, dignity, and autonomy within a community setting.(as) "Targeted case management" means the collaborative process of assessment, planning, facilitation, advocacy, coordination, and monitoring performed by the case manager that is accomplished with a person-centered program, and which: (1) Assists participants to gain access to needed CFI waiver services, services contained in the medicaid state plan, and other medical, social, spiritual, vocational, educational, and community supports, regardless of the funding source; and(2) Provides for coordination of participant service plans from all providers to assure adequacy and appropriateness of care and cost effectiveness of planned services that yield positive outcomes.N.H. Admin. Code § He-E 801.02
(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11
Amended by Volume XXXIX Number 32, Filed August 8, 2019, Proposed by #12830, Effective 8/7/2019, Expires 2/3/2020.Amended by Volume XLII Number 6, Filed February 10, 2022, Proposed by #13340, Effective 1/29/2022, Expires 1/29/2032.