N.H. Admin. Code § He-M 504.03

Current through Register No. 50, December 12, 2024

Section He-M 504.03 - Roles and Responsibilities of Providers and Provider Agencies

(a) All provider agencies shall obtain and maintain certifications for community residences, enhanced family care shared living residential habilitation services, and adult day community participation services in accordance with He-M 507 or He-M 1001, as applicable.

(b) All providers and provider agencies shall be responsible for the following:

(1) Participating in person-centered service planning in accordance with He-M 503, He-M 522, and He-M 524;

(2) Ensuring service delivery is led by the individual and family, if chosen by the individual, and promotes community involvement, relationship development, independence, societal contribution, enhancement of individual communications, and aligns with an individual's service agreement and in accordance with RSA 171-A;

(3) Reviewing the service agreement to ensure:

a. That all provider agencies review and sign the service agreement in accordance with He-M 503, He-M 522, and He-M 524, as applicable, to indicate that they agree to provide services in the amount, scope, frequency and duration, as outlined; and

b. That all providers review the service agreement relative to the service that they will be providing prior to service provision;

(4) Ensuring that all services and supports are provided in accordance with He-M 310, He-M 503, He-M 517, He-M 522, He-M 524, and He-M 1201, as applicable;

(5) Creating and maintaining documentation in accordance with He-M 503, He-M 517, He-M 522, He-M 524, and He-M 1201, as applicable;

(6) Providing documentation of service planning, monitoring, and billing related to the service being provided, within 30 days of the request from the following entities, unless otherwise stated in rule, as follows:

a. To the department;

b. To area agencies, regarding information that is necessary for area agencies to complete their responsibilities pursuant to He-M 505; and

c. To service coordinators, regarding information that is necessary for the service coordination provider agency and service coordinator to complete their responsibilities pursuant to He-M 500;

(7) Providing documentation in (6) above within 3 business days in circumstances when the information is needed to support crisis planning;

(8) Participating in activities with the area agency that are necessary to complete its responsibilities pursuant to He-M 505;

(9) Participating in crisis mitigation and management which includes, but is not limited to, identifying alternative placement options, sharing information with other provider agencies and providers, and participating in crisis management meetings;

(10) Documenting and submitting to service coordination agencies and notifying guardians, if applicable, incident reports regarding critical incidents;

(11) Documenting and submitting to area agencies incident reports regarding critical incidents when the service coordination agency is the reporting entity; and

(12) Managing responses to areas of risk, in accordance with He-M 503, He-M 522, and He-M 524 and by:

a. Reviewing and analyzing incidents related to violent aggression, problematic sexual behaviors, or fire-setting behaviors as they pertain to service planning and provision;

b. Notifying service coordinators of the presentation of incidents in accordance with (a) above;

c. Presenting to committees and other groups related to risk management, when invited by the service coordinator, including, but not limited to, local human rights committees, statewide and local risk management committees, and community of practice to determine application of assessment recommendations received, when the provider agency participated in the plan development;

d. Ensuring documentation of activities and progress in treatment relative to management of risk for an individual to help inform the person-centered development of plans;

e. Ensuring that agency personnel and contractors receive clinically specialized trainings, based on assessed needs of the individuals supported, that enable these personnel to successfully complete risk management activities;

f. Ensuring participation in risk management training activities; and

g. Ensuring that plans are reviewed regularly with individuals and their treatment team to consider ongoing appropriateness and, in the event that potential changes are indicated, seeking additional consultation with providers qualified to conduct and author assessments, whether they created the initial plans or are new, to discuss opportunities for modification of restrictions by sharing data regarding the individual's updated progress in treatment.

(c) In addition to the requirements in He-M 504.03(b)(9) for response to management of risk, service coordination provider agencies and service coordination providers shall:

(1) Make referrals, as applicable, to the appropriate area agency's local risk management committee for individuals exhibiting violent aggression, problematic sexual behaviors, or fire-setting behaviors for evaluations or planning activities initially and ongoing;

(2) Arrange for assessments or evaluations resulting from local human rights committee recommendations; and

(3) Participate in and present to committees and other groups related to risk management including, but not limited to, local human rights committees, statewide and local risk management committees and communities of practice to determine application of assessment recommendations received.

(d) All service coordination agencies shall document sentinel events and submit reports to the applicable area agency for finalization in accordance with RSA 126-A:4.

(e) All provider agencies shall be able to be contacted during their published hours of business, as indicated in the medicaid provider enrollment process.

(f) In addition to (e) above, all home and community based waiver community residence and enhanced family care shared living residential habilitation provider agencies and service coordination provider agencies shall be accessible 24/7 and have an on-call system for emergency access outside of regular business hours to ensure response within 30 minutes by a representative with decision-making authority.

(g) Each provider agency must complete a New Hampshire criminal records check no more than 30 days prior to hire and prior to working with any individual, and every other year thereafter, for all of its providers, staff, contractors, and volunteers who will have direct contact with individuals or families and:

(1) If the applicable provider, staff, contractor or volunteer's primary residence is out of state, a criminal records check for their state of residence shall be completed prior to working with any individual, and every other year thereafter; or

(2) If the applicable provider, staff, contractor or volunteer has resided in New Hampshire for less than one year, a criminal records check for their previous state(s) of residence shall be completed prior to working with any individual.

(h) Each provider agency shall complete a check of the division of children, youth and families (DCYF) state registry, pursuant to RSA 169-C:35 for all of its providers, staff, contractors, and volunteers who will have direct contact with individuals or families, prior to working with any individual and every other year thereafter.

(i) Each provider agency shall complete a check of the registry of founded reports of abuse, neglect, and exploitation pursuant to RSA 161-F:49 for all of its providers, staff, contractors, and volunteers who will have direct contact with individuals and families prior to working with any individual and every other year thereafter.

(j) Each provider agency shall obtain an attestation from all of its providers, staff, contractors, and volunteers who will have direct contact with individuals or families in the year in between the checks required pursuant to (g)-(i) above that they have not:

(1) Been convicted of a felony or misdemeanor in this or any other state; and

(2) Had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

(k) Except as allowed in (l) and (m) below, a provider agency shall not hire a person, or permit them to volunteer:

(1) Who has a:

a. Felony conviction; or

b. Any misdemeanor conviction involving:

1. Physical or sexual assault;

2. Violence;

3. Exploitation;

4. Child pornography;

5. Threatening or reckless conduct;

6. Theft;

7. Driving under the influence of drugs or alcohol; or

8. Any other conduct that represents evidence of behavior that could endanger the well-being of an individual; or

(2) Whose name is on either of the state registries of founded abuse, neglect, and exploitation as established by RSA 161-F:49 and RSA 169-C:35.

(l) A provider agency may hire a person, or permit the person to volunteer, with a criminal record listed in (k)(1) a. or b. above for a single offense that occurred 10 or more years ago in accordance with (m) and (n) below. In such instances, the individual, their guardian if applicable, and the provider agency shall review the person's history prior to approving the person's employment.

(m) Employment of a person pursuant to (l) above shall only occur if such employment:

(1) Is approved by the individual, their guardian, if applicable, and the provider agency;

(2) Does not negatively impact the health or safety of the individual; and

(3) Does not affect the quality of services to the individual.

(n) Upon hiring or permitting a person to volunteer pursuant to (l) and (m) above, the provider agency shall document and retain the following information in the individual's record:

(1) The date(s) of the approvals in (l) above;

(2) The name of the individual for whom the person will provide services;

(3) The name of the person hired or permitted to volunteer;

(4) Description of the person's criminal offense;

(5) The type of service the person is hired or volunteering to provide;

(6) The provider agency's name and address;

(7) A full explanation of why the provider agency is hiring or allowing the person to volunteer despite the person's criminal record;

(8) Signature of the individual, or of the legal guardian(s) if applicable, indicating agreement with the employment and date signed;

(9) Signature of the provider agency staff person who obtained the individual or guardian's signature and date signed;

(10) Signature of the provider agency's executive director or designee approving the employment; and

(11) The signature and phone number of the person being hired or permitted to volunteer.

(o) In instances when obtaining the checks required in (g)-(h) would delay a provider agency's ability to have a provider, staff, contractor, or volunteer provide services, the provider agency shall obtain a self-attestation from the prospective provider, staff, contractor, or volunteer to attest that they have not:

(1) Committed a felony or misdemeanor in this or any other state; and

(2) Had a finding by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect, or exploitation of any person.

(p) Self-attestations obtained in accordance with (o) above shall be accepted while the provider agency is awaiting the results of the checks required in (g)-(h) above, but shall not be valid for more than 90 days once signed. Individual and guardian approval shall be obtained if a provider, staff, contractor or volunteer will work directly with an individual and not under the supervision of a provider, staff, contractor or volunteer with completed checks pursuant to (g)-(h) above.

(q) Each provider agency shall check the office of the inspector general exclusion list prior to hire and monthly thereafter with regard to checking names of prospective or current providers, staff, and contractors.

(r) Each provider agency shall ensure all providers, staff, contractors, and volunteers who drive individuals, in their own vehicle or agency vehicle, have a valid driver's license.

(s) Each provider agency, provider, staff, contractor, and volunteer is a mandated reporter and shall report to the appropriate department authority any individual who is suspected of being abused, neglected, exploited, or self-neglecting, in accordance with, RSA 161-F:46 and RSA 169-C:35, and pursuant to He-M 202, any individual who is suspected of being abused, neglected, exploited, or having had their service rights violated, in accordance with He-M 310.

(t) Each provider agency shall report instances of restraint and seclusion to each individual's area agency not less than quarterly.

(u) Provider agencies shall collect any applicable room and board payments.

(v) Provider agencies shall collect any applicable cost of care payments.

N.H. Admin. Code § He-M 504.03

Derived from Number 28, Filed July 13, 2023, Proposed by #13679, EMERGENCY RULE, Effective 6/28/2023, Expires 12/25/2023.

Amended by Number 50, Filed December 14, 2023, Proposed by #13807, Effective 11/17/2023, Expires 11/17/2033.