Section He-W 531.06 - Non-Covered Services(a) Physician services for the surgery, inpatient hospital services for the surgical admission(s), and organ procurement services related to the following types of transplants shall be non-covered services:(1) Any type of organ transplant not specified in He-W 531.05(b) or tissue transplant not specified in He-W 531.05(a)(13);(2) Organ transplants requiring prior authorization but which are not prior authorized; or(3) More than 2 transplants of the same type of organ per recipient per lifetime.(b) Psychiatric services when provided at or through a community mental health center shall be non-covered as a physician service.(c) Treatment shall be non-covered when the sole purpose is to contribute to, promote, or restore fertility, procreation, or sexual activity.(d) Procedures or surgery for the sole purpose of preserving or improving appearance shall be non-covered, except when required for the prompt repair of accidental injury or for the improvement of the functioning of a malformed body member.(e) With the exception of procedures covered in accordance with the coverage criteria in He-W 531.05(b)-(g), experimental or investigational procedures described as such in the National Coverage Determinations (NCD) found in the Centers for Medicare and Medicaid Services "Medicare Coverage Database" at http://www.cms.gov/medicare-coverage-database/ (under the "Quick Search" function, select "National Coverage Documents", optionally enter a filter by entering a "keyword" to narrow the search results, and select the "Search by Type" button, or, if a keyword is not entered, the entire list of NCD titles will appear alphabetically and may be selected) shall be non-covered.(f) Thermogenic therapy, which treats certain types of resistant infectious diseases through the production of artificial fever, shall be non-covered.(g) Electrosleep therapy, which consists of the application of pulses of direct current to the recipient's brain through external electrodes, shall be non-covered.(h) Any services directly related to a non-covered service or procedure shall be non-covered.(i) Inpatient hospital visits for non-acute inpatient stays shall be non-covered, including but not limited to: (1) Visits to recipients who are in an inpatient hospital setting awaiting placement to a long term care facility; and(2) Visits for days that have not been approved by the department or its designated Quality Improvement Organization (QIO) in accordance with He-W 543.(j) Components of surgical preparatory regimens that are not described as covered services in accordance with He-W 520 through He-W 577 shall be non-covered, including: (1) Services rendered by dieticians or nutritionists; andN.H. Admin. Code § He-W 531.06
Amended by Volume XXXIV Number 16, Filed April 17, 2014, Proposed by #10531, Effective 3/29/2014, Expires3/29/2024.Amended by Volume XXXVII Number 45, Filed November 09, 2017, Proposed by #12403, Effective 10/20/2017, Expires 10/20/2027.Amended by Volume XXXIX Number 28, Filed July 11, 2019, Proposed by #12818, Effective 7/1/2019, Expires 7/1/2029.Amended by Volume XL Number 11, Filed March 12, 2020, Proposed by #12999, Effective 3/5/2020, Expires 3/5/2030.