N.H. Admin. Code § He-M 426.02

Current through Register No. 50, December 12, 2024

Section He-M 426.02 - Definitions

The words and phrases in this rule shall mean the following:

(a) "Assertive Community Treatment (ACT) " means the evidence-based practice of delivering comprehensive and effective services to individuals by a multidisciplinary team primarily in their homes, communities, and other natural environments.

(b) "Acute episode" means a sudden, generally unexpected, debilitating, and precipitous event in a psychiatric disorder.

(c) "Advanced practice registered nurse (APRN) " means a registered nurse who is licensed as having specialized clinical qualifications as provided in RSA 326-B:18 and is certified in psychiatric mental health.

(d) "Affiliated agency" means an agency that provides mental health or related services to individuals served by a community mental health program and that coordinates services and service planning with the community mental health program.

(e) "Commissioner" means the commissioner of the department of health and human services.

(f) "Community mental health program (CMHP) " means a program operated by the state, city, town, or county, or a community based New Hampshire nonprofit corporation for the purpose of planning, establishing, and administering an array of community-based, mental health services pursuant to He-M 403 and as defined in RSA 135-C:2, IV.

(g) "Community mental health provider" means a medicaid provider of community mental health services that has been previously approved by the commissioner to provide specific mental health services pursuant to He-M 426.

(h) "Competitive employment" means community-based employment at prevailing wage jobs, which reflect consumer preferences, strengths, and goals. The term includes positions in mainstream settings that are part or full time for any number of hours and result in payment of the Federal Insurance Contributions ACT (FICA) tax. The term refers to employment in which an individual earns the same pay and benefits as everyone else who holds the same position. The term includes self-employment that results in, or has the potential to result in, payment of the Self-Employment Contributions Act Tax (SECA) . The term does not include employment that is set aside for mental health consumers or work that is controlled by a service agency.

(i) "Continuous treatment team" means a team of licensed practitioners of the healing arts and other mental health clinicians whose caseload is 12 or fewer individuals per direct service staff and who provide intensive treatment through an array of services to individuals who have mental illness and may have a history of substance abuse.

(j) "Covered services" means rehabilitative, treatment, and other community mental health services that are funded by the department and are available through CMHPs, community mental health providers, or agencies affiliated with such programs or providers.

(k) "Current Procedural Terminology" means a listing of descriptive terms and identifying codes for reporting and billing medical services and procedures, developed by the American Medical Association (AMA) in 2007 CPT available as listed in Appendix A.

(l) "Department" means the New Hampshire Department of Health and Human Services.

(m) "Evidence-based practices" means mental health practices that have consistently demonstrated their ability to help consumers achieve desired outcomes in mental health service research trials, where such trials have been conducted by multiple researchers with similar outcomes.

(n) "Evidence-based supported employment (EBSE) " means the provision of vocational supports to individuals following the Supported Employment Evidence Based Practice Kit (2010), available as listed in Appendix A, to ensure successful competitive employment in the community.

(o) "Facility" means New Hampshire hospital or a receiving facility designated pursuant to RSA 135-C:26 and He-M 405, Glencliff Home, or an acute psychiatric residential treatment program.

(p) "Functional support services" means medically necessary individual and group interventions that support optimal functioning and enhance resiliency, recovery, and integration in the community.

(q) "Family member" means the parent, foster parent, legal guardian, child, stepchild, brother, sister, spouse, significant other, grandparent, grandchild, stepparent, aunt, uncle, or first cousin of the individual.

(r) "Illness management and recovery (IMR) " means a specific set of services aimed at promoting recovery that are based on the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A.

(s) "Individual" means any person receiving or applying for services from a program or community residence. The term includes client.

(t) "Individual service plan (ISP) " means a written proposal that:

(1) Is developed annually as the result of a service planning process pursuant to He-M 401; and

(2) Includes the identification of an individual's:

a. Goals and objectives;

b. Treatments and services;

c. Timelines for achieving the stated goals; and

d. Referrals to other specialized health services when appropriate.

(u) "Individualized resiliency and recovery oriented services (IROS) " means the following set of services:

(1) Illness management and recovery (IMR);

(2) Supported employment (SE);

(3) Crisis intervention;

(4) Therapeutic behavioral services;

(5) Family support; and

(6) Medication support.

(v) "Institution for mental diseases (IMD) " means a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services. Further, an institution is an IMD if its overall character is that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases.

(w) "Intensive partial hospitalization services" means clinically oriented programs designed to promote stabilization and rapid amelioration of the symptoms of any combination of acute or severe psychiatric disturbances.

(x) "Licensed practitioner of the healing arts" means a person who provides psychotherapy or other services identified pursuant to He-M 426 and meets the qualifications of He-M 426.08(h) .

(y) "Long-term care" means services covered by Medicaid for Medicaid recipients who have been determined eligible pursuant to the criteria outlined in He-M 401.

(z) "Mental illness" means a condition of a person who is determined severely mentally disabled in accordance with He-M 401.05 through He-M 401.07 and who has at least one of the following psychiatric disorders classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as listed in Appendix A:

(1) Schizophrenia spectrum and other psychotic disorders except for the following:

a. Schizotypal personality disorder;

b. Substance or medication induced psychotic disorder; and

c. Psychotic disorder due to another medical condition;

(2) Bipolar and related disorders except for the following:

a. Substance or medication induced bipolar and related disorder; and

b. Bipolar disorder and related disorder due to another medical condition;

(3) Depressive disorders except for the following:

a. Disruptive mood dysregulation disorder;

b. Premenstrual dysphoric disorder;

c. Substance or medication induced depressive disorder; and

d. Depressive disorder due to another medical condition;

(4) Borderline personality disorder;

(5) Panic disorder;

(6) Obsessive compulsive disorder;

(7) Post traumatic stress disorder;

(8) Bulimia nervosa;

(9) Anorexia nervosa;

(10) Other specific feeding or eating disorders;

(11) Unspecified feeding or eating disorders; and

(12) Major neurocognitive disorders where psychiatric symptom clusters cause significant functional impairment and one or more of the following symptom categories are the focus of psychiatric treatment:

a. Anxiety;

b. Depression;

c. Delusions;

d. Hallucinations; and

e. Paranoia.

(aa) "Natural support" means a reference to people in a variety of roles who are engaged in supportive relationships with people in recovery outside of behavioral health settings. Examples of natural supports include family, friends, and other loved ones, landlords, employers, neighbors, or any other person who plays a positive, but non-professional, role in someone's recovery.

(ab) "Not otherwise classified" means a category of covered CMHP services consisting of treatment or services rendered which do not meet the requirements of the procedures identified in He-M 426.07 - He-M 426.14 but meet the requirements identified pursuant to He-M 426.14(b) .

(ac) "Nursing facility" means an institution as defined pursuant to He-E 802.01(s) .

(ad) "Pre-admission screening and resident review (PASRR) " means procedures by which the department, in conformance with section 1919(b) (3) (F) (i) and (ii) of the Social Security Act, determines whether persons with mental illness who are applying for placement or currently residing in nursing facilities are in need of nursing facility level of service and, if so, whether they are in need of specialized services pursuant to He-M 1302.07.

(ae) "Peer support specialist" means CMHP staff who self-identify as having experience with a mental health or substance use condition and who chooses to become a service practitioner in the health care system.

(af) "Psychotherapy" means face to face clinical intervention or assessment and monitoring necessary to determine the course and progress of therapy that:

(1) Is based on psychological treatment principles;

(2) Has as its purpose the improvement of interpersonal and self-care skills, psychological understanding, or a change in behavior(s), or any combination of these;

(3) Is provided by a professional qualified pursuant to He-M 426.08(h) -(l) ;

(4) Is monitored through the clinical record; and

(5) Is based on an ISP.

(ag) "Recipient" means an individual who is eligible for reimbursement of CMHP and community mental health provider services under the state medicaid program.

(ah) "Restorative partial hospitalization services" means evidenced informed services that address integrated health care goals and objectives and are intended to impact the person's whole health status, improve physical and overall health status indicators, as these factors have an important impact the individual's mental health, maximize a recipient's strengths, increase his or her ability to function in his or her living environments, and lead to integration of the recipient into the community.

(ai) "Serious emotional disturbance (SED) " means severe mental disability in persons under the age of 18, and includes all psychiatric disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) -5 with the exception of developmental disabilities, intellectual disabilities, neurocognitive disorders, anti-social personality disorders, and and conditions "due to another medical condition."

(aj) "State fiscal year" means the period of time extending from July 1 of one year through June 30 of the following year.

(ak) "Subcontractor" means an person or organization that enters into an agreement with a CMHP to receive payments from the CMHP for the delivery of medicaid funded mental health services described in an ISP.

(al) "Transitional employment" means time-limited employment for the purpose of vocational assessment or training.

(am) "Unit" means a period of time during which services are rendered. Where units refer to a specific length of time, units are reimbursed in whole units and time of service is rounded to the nearest whole unit.

(an) "Visit" means all services provided to a recipient per appointment or encounter with a provider.

(ao) "Work preparation" means interventions that assist in obtaining or maintaining competitive employment, and may include cues for social norms and activities of daily living (ADL) .

N.H. Admin. Code § He-M 426.02

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5971, eff 2-1-95; amd by #6568, eff 8-22-97; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08; ss by #9581, eff 10-24-09; amd by #12079, eff 12-29-16

Amended by Volume XXXVII Number 15, Filed April 13, 2017, Proposed by #12154, Effective 3/28/2017, Expires 3/28/2027.