N.H. Admin. Code § He-E 801.33

Current through Register No. 50, December 12, 2024

Section He-E 801.33 - Required Documentation

(a) All providers, with exceptions noted in (b) below, shall develop, maintain, and implement a written provider care plan and adhere to the following:

(1) The provider shall communicate with the participant's case manager to ensure the care plan is consistent with and addresses the applicable service needs and the participant's preferences identified in the comprehensive care plan;

(2) The provider care plan shall contain, at a minimum:

a. A description of the participant's needs and the scope of services to be provided;

b. The dates upon which services will begin and end;

c. The frequency of the services;

d. The total number of service units authorized and the amount that will be provided on each date of service;

e. Pertinent information on the participant's health condition, medications, allergies, and special dietary needs; and

f. The anticipated goals and outcomes of service provision;

(3) The provider care plan shall be updated at least annually and as necessary to reflect change in the participant's need for services; and

(4) The provider shall provide a copy of the provider care plan to the participant's case manager, upon the completion or revision of the plan, and shall make the provider care plan available to the department upon request.

(b) Providers of the following services shall not be required to develop a provider care plan:

(1) EAS;

(2) Home-delivered meals services;

(3) Non-medical transportation services;

(4) Personal emergency response system services;

(5) Financial management services;

(6) Specialized medical equipment services; and

(c) All providers shall:

(1) Maintain documentation in accordance with applicable licensure, certification, and all other applicable federal and state laws and regulations or other requirements;

(2) Maintain any other supporting records in accordance with He-W 520; and

(3) Maintain documentation in their records to fully support each claim billed for services including the specific service provided, the number of service units provided, the name of the employee who provided the service, and the date and time of service provision, as applicable.

(d) Failure to maintain supporting records in accordance with He-W 520 and this part shall entitle the department to recoupment of state and federal medicaid payments pursuant to 42 CFR 455, 42 CFR 447, and 42 CFR 456.

(e) In addition to (c) above, documentation of PCS shall include verification of the PCS worker's time, including:

(1) When paper timesheets are used, the signature of the participant or PCS representative indicating the reported hours are accurate, the service was provided in accordance with the provider care plan, and the service was to the participant's satisfaction; or

(2) Certification that the service was provided in accordance with the electronic visit verification requirement of 42 USC 1396b(l) and the provider care plan and the service was to the participant's satisfaction.

(f) The documentation required by this section shall be made available to the department upon request.

(g) The documentation required by this section shall be maintained for a period of at least 6 years from the date of service or until the resolution of any legal action(s) commenced during the 6 year period, whichever is longer.

N.H. Admin. Code § He-E 801.33

(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 (formerly He-E 801.30).