Section He-M 1302.06 - Categorical Decisions(a) An applicant shall be predetermined eligible for nursing facility services if he or she needs nursing facility services pursuant to He-M 1302.07 and meets one of the following criteria: (1) Has a terminal condition and is not a danger to self or others;(2) Has a severe physical condition that has resulted in extreme impairment, such as coma, ventilator dependence, or functioning at the brain stem level;(3) Requires a temporary admission because further assessment cannot be made until delirium resolves;(4) Requires emergency admission for protective services;(5) Requires respite for the caregiver of the applicant with MI or DD; or(6) Requires convalescent care and rehabilitative services, is admitted directly from an acute care hospital, and requires services for the condition for which he or she received care at the hospital.(b) An applicant admitted pursuant to (a) (3) above shall be predetermined eligible for facility admission and services for 30 days.(c) An applicant admitted pursuant to (a) (4) above shall be predetermined eligible for facility admission and services for 7 days.(d) An applicant admitted pursuant to (a) (5) above shall be eligible for services totaling 20 days during any one-year period beginning on the month and day of the earliest date of respite service.(e) An applicant admitted pursuant to (a) (6) above shall be predetermined eligible for the number of days specified by the applicant's physician if: (1) The admission is ordered by the applicant's physician;(2) The order does not exceed 99 days;(3) Notice was provided pursuant to He-M 1302.03(e) ; and(4) The referring physician has indicated that the applicant does not need long-term placement in a nursing facility but does need short-term convalescence or rehabilitation to allow the applicant to return to a residential placement in the community.(f) An applicant admitted pursuant to (a) (1) or (2) above shall be evaluated for the need for specialized services pursuant to He-M 1302.10 or He-M 1302.11 if the medical condition improves to the extent that the individual might respond to services for his or her MI or DD.(g) A nursing facility shall notify the PASRR office no less than 9 days prior to the expiration of the time period allowed under (b), (d), or (e) above that the applicant's stay is likely to exceed the allowed period.(h) An applicant admitted pursuant to (a) (3) -(6) above and whose nursing facility stay is expected to continue beyond the number of days allowed under (b) -(e) shall undergo a level II evaluation and determination prior to the end of the allowed timeframe.(i) For the purposes of (a) (2) above, cerebral palsy, in and of itself, shall not constitute a severe physical condition or be a criterion for predetermination of eligibility for nursing facility services.(j) An applicant with a diagnosis of DD shall be screened for the need for nursing facility services regardless of a diagnosis of Alzheimer's disease, dementia, or a related disorder.(k) Applicants admitted pursuant to (a) (3) -(5) above shall be predetermined to not require specialized services.N.H. Admin. Code § He-M 1302.06
#6063 eff 8-1-95; ss by #7920, INTERIM, eff 8-2-03, EXPIRED: 1-29-04
New. #8035, eff 2-7-04; amd by #8430, eff 9-17-05; paras (a)-(d) and (f)-(g) expired 2-7-12; amd by #10123, INTERIM, eff 4-30-12, EXPIRES: 10-29-12; ss by #10216, eff 10-29-12