Section He-W 540.01 - Definitions(a) "Clinically appropriate" means care that is:(1) Provided in a timely manner and meets professionally recognized standards of acceptable medical care;(2) Delivered in the appropriate medical setting; and(3) The least costly of multiple, equally effective alternative treatments or diagnostic modalities.(b) "Department" means the New Hampshire department of health and human services.(c) "Medicaid" means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.(d) "Order" means a written authorization issued by a licensed practitioner for medications, treatments, recommendations, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.(e) Licensed practitioner" means: (2) Physician's assistant;(3) Advanced practice registered nurse (APRN); or(4) Any practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.(f) "Plan of care" means a plan of care prepared in accordance with 42 CFR 484.60.(g) "Prior authorization agent" means an individual or organization contracted by the department, responsible for reviewing prior authorization requests.(h) "Private duty nursing (PDN)" means the provision of skilled nursing services for recipients who require more individual and continual skilled nursing observation, judgment, assessment, or interventions than are available from a visiting nurse, in contrast to part-time or intermittent care, such as wound care.(i) "Reasonable attempt" means such action taken to accomplish the purpose as may be customary, appropriate, and suitable to the circumstances and that is in the best interests of the recipient.(j) "Recipient" means any individual who is eligible for and receiving medical assistance under the medicaid program.(k) "Skilled nursing services" means services that are provided by a registered nurse (RN) or a licensed practical nurse (LPN) because the nature of the service is inherently complex or the recipient's condition is such that the service can be safely and effectively provided only by a licensed nurse in accordance with the nurse practice act, RSA 326-B.(l) "Title XIX program" means the joint federal-state program described in Title XIX of the Social Security Act (SSA) and administered in New Hampshire by the department under the medicaid program.(m) "Title XXI" means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.N.H. Admin. Code § He-W 540.01
(See Revision Note at chapter heading He-W 500); ss by #6134, eff 11-30-95, EXPIRED: 11-30-03
New. #8069, eff 4-17-04; ss by #10107, INTERIM, eff 4-17-12, EXPIRES: 10-15-12; amd by #10139, eff 7-1-12; ss by #10186, eff 10-15-12
Amended by Number 6, Filed February 9, 2023, Proposed by #13544, Effective 1/28/2023, Expires 1/28/2033.