N.H. Admin. Code § He-E 805.04

Current through Register No. 50, December 12, 2024

Section He-E 805.04 - Provider Agency Requirements

(a) Case management agencies shall:

(1) Comply with the requirements contained in He-E 801.29, including the requirement to be enrolled as a medicaid provider; and

(2) Be licensed in accordance with requirements of state law, including RSA 151.

(b) Case management agencies shall employ a full-time administrator responsible for the development and implementation of the policies of the case management agency and for compliance with applicable rules.

(c) Case management agencies shall establish and maintain agency written policies and procedures regarding the following areas, and shall ensure that they are properly followed and enforced:

(1) Completion and documentation of a criminal background check for all employees pursuant to RSA 151:2-d;

(2) A process for confirming that each employee is not on the NH central registry of abuse, neglect or exploitation pursuant to RSA 169-C:35 or BEAS state registry established pursuant to RSA 161-F:49;

(3) Verification of discipline specific licensing for those employees whose profession requires licensing;

(4) The requirements for the mandated reporting of abuse, neglect, or exploitation in accordance with RSA 161-F: 46;

(5) The procedures for reported complaints, incidents, and sentinel events;

(6) Staff orientation including, at a minimum, a review of:

a. The federal and state laws and rules governing the CFI program;

b. The local community service network;

c. The procedures for crisis intervention; and

d. The philosophy governing person-centered planning, as defined in He-E 805.02(q) ;

(7) Staff development, including procedures for addressing performance or training needs;

(8) Staff performance evaluations, including how performance or training needs will be addressed throughout the case manager's employment tenure;

(9) A clinical supervision protocol which includes, at a minimum:

a. Monthly meetings between the case manager and his or her supervisor; and

b. As a focus of supervision, the review of participant records to ensure compliance with the requirements described in He-E 805.04(f) and He-E 805.05(b) -(d) ;

(10) Participant complaints, including how participants are informed about the agency's policies and procedures;

(11) Evaluation of participant satisfaction with the agency and the case manager, and how a participant may request a change in case manager or case management agency;

(12) Procedures for protection of participant records that govern use of records, storage, removal, conditions for release of information, and compliance with the Health Insurance Portability and Accountability Act (HIPAA); and

(13) Procedures related to quality assurance and quality improvement.

(d) Case management agencies shall accept assignments made, pursuant to He-E 805.07(b) , according to the system maintained by the department's bureau of elderly and adult services (BEAS) unless there is a conflict of interest or the agency has informed BEAS in writing that it must be temporarily removed from the list of available agencies due to staffing shortages.

(e) Case management agencies shall maintain access to a toll free number for all participants served and respond to calls as follows:

(1) Responses to calls received on Monday through Friday shall be made within 24 hours; and

(2) Responses to calls received on Saturdays, Sundays, and holidays shall be made within 48 hours.

(f) Case management agencies shall maintain an individual case record for each participant receiving case management services which includes:

(1) A face sheet describing demographic and other important information, including:

a. The participant's name, date of birth, and address;

b. The participant's medicaid identification number; and

c. The name, phone number, and address of the participant's emergency contact person;

(2) The comprehensive assessment document, described in He-E 805.05(b) below;

(3) The comprehensive care plan, described in He-E 805.05(c) below;

(4) The CFI MEA assessment and MEA needs list or support plan;

(5) Medicaid financial eligibility information, including the cost share described in He-E 801.11;

(6) Release of information forms;

(7) Progress notes that reflect areas contained in the comprehensive care plan;

(8) All contact notes, including those required by He-E 805.05(d) (1) below;

(9) A written record of all monitoring and case management activities;

(10) All pertinent correspondence relating to the participant's case management; and

(11) Any and all electronic records.

N.H. Admin. Code § He-E 805.04

#9242, eff 8-26-08

Amended by Volume XXXVI Number 36, Filed September 8, 2016, Proposed by #11167, Effective 8/25/2016, Expires 2/21/2017.

Amended by Volume XXXVII Number 10, Filed March 9, 2017, Proposed by #12115, Effective 2/22/2017, Expires 2/22/2027.