N.H. Admin. Code § He-M 504.06

Current through Register No. 45, November 7, 2024

Section He-M 504.06 - Pass-Through Billing

(a) Pass-through billing shall be permissible for the following home and community based waiver services:

(1) Assistive technology;

(2) Environmental and vehicle modification services;

(3) Individual goods and services;

(4) Non-medical transportation;

(5) Personal emergency response system;

(6) Community integration services;

(7) Respite;

(8) Wellness coaching; and

(9) Specialty services for assessments, consultations, and evaluations.

(b) An OHCDS that provides pass-through billing shall:

(1) Establish itself as the enrolled provider for the home and community based waiver service(s) in (a) above for which pass-through billing will be done;

(2) Hold a contract or other agreement with a provider or provider agency for service provision, except that provision of goods, other than environmental or vehicle modifications, shall not require a contract or agreement;

(3) Ensure that the providers and provider agencies with whom it contracts, or has agreements with, meet:

a. The service and provider qualification standards under the applicable home and community based services waiver, He-M 504 and He-M 506 to provide the services pursuant to (1) above;

b. Medicaid requirements and are free from sanctions or exclusions or are otherwise not excluded from receiving medicaid reimbursement;

c. Medicaid office of inspector general screening requirements prior to service delivery and monthly thereafter;

d. All federal and state rules and requirements; and

e. All applicable regulatory and industry standards and maintains good standing as a provider agency;

(4) Submit claims to MMIS for rendered services and goods and ensure that records are maintained to verify that such services and goods were provided in the amount, scope, and frequency that was claimed;

(5) Reimburse subcontractors;

(6) Submit to the bureau within 30 days of the close of the state fiscal year, in addition to all other required reports and statements, an aggregate annual summary delineating OHCDS activities, including subcontractor names, amounts paid per subcontractor, nature of services, and number of individuals served by each subcontractor;

(7) Ensure that it maintains detailed records, available for the department, its designee, or respective individual, at request for review at any time, to verify the purchase of services and goods outlined in (a) above; and

(8) Ensure that policies and practices do not:

a. Restrict any home and community-based waiver services provider agency or provider to participate only through an OHCDS and that such arrangements are voluntary; and

b. Restrict individuals into securing services exclusively through an OHCDS.

N.H. Admin. Code § He-M 504.06

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.