Section He-M 523.04 - Determination of Eligibility(a) The medical documentation provided pursuant to He-M 523.03(b) , and any other information provided by the applicant concerning the applicant's unconfirmed chronic health condition, shall be the basis for determination of eligibility for services.(b) A PIH coordinator shall review the medical documentation received regarding an applicant and, within 15 business days after the receipt of the documentation, confirm the applicant has a chronic health condition as defined by He-M 523.02(d) .(c) In cases where the information regarding eligibility is inconclusive, a SMS clinician shall make the determination of an applicant's eligibility.(d) If the information required to determine eligibility cannot be obtained or it is anticipated that the person will not be determined eligible in consultation with SMS within the timelines stated in (b) above, the PIH coordinator shall: (1) Request an extension from the applicant, in writing, stating the reason for the delay; and(2) Obtain the approval in writing from the applicant.(e) Extensions approved in writing by the applicant in (d) above shall not exceed 30 business days after the receipt of the documentation.(f) If the PIH coordinator's request for an extension pursuant to (d) above is denied by the applicant, the PIH coordinator shall determine the applicant to be ineligible for services. The young adult or family may reapply for services pursuant to (k) below.(g) The PIH coordinator shall authorize services to be provided prior to the completion of the eligibility determination process if such services are necessary to protect the health or safety of an applicant who the PIH coordinator believes is likely to be eligible, based upon available information.(h) Within 5 business days of the determination of a family's or a young adult's eligibility, a PIH coordinator shall send notice to each applicant that includes the determination of eligibility.(i) Preliminary planning to determine the services needed shall occur with the young adult or family when the application is submitted or no later than 5 business days from the notification of eligibility.(j) Within 5 business days of determination of an applicant's ineligibility, a PIH coordinator shall convey to the applicant a written decision that describes the specific legal and factual basis for the denial, including specific citation of the applicable law or department rule, and advise the applicant in writing and verbally of the appeal rights under He-M 523.12.(k) Following denial of eligibility, the individual, family, as applicable, may reapply for services if new information regarding the diagnosis or of the health condition becomes available or if the timelines are not met in accordance with (f) above.(l) The determination of eligibility by one PIH coordinator shall be accepted by every lead agency of the state.(m) On an annual basis, the PIH coordinator shall re-determine the eligibility of a young adult or family through the review of the young adult's or family's action plan.(n) Young adults and families shall make the necessary medical and other forms of documentation concerning the chronic health condition available upon request from the PIH coordinator, SMS or the lead agency.N.H. Admin. Code § He-M 523.04
#7713, eff 6-21-02; ss by #9728, eff 6-18-10
Amended by Volume XXXVIII Number 28, Filed July 12, 2018, Proposed by #12557, Effective 6/26/2018, Expires 12/24/2018.The amended version of this section by New Hampshire Register Volume 39, Number 02, eff.12/28/2018 is not yet available.
The amended version of this section by New Hampshire Register Number 32, eff. 7/22/2023 is not yet available.