Section He-W 619.02 - Presumptive Eligibility For HCBC-ECI(a) Presumptive eligibility for medicaid services shall be available to the applicant: (1) Who applies for HCBC-ECI;(2) Who requests a presumptive eligibility determination, either directly or through a qualified provider;(3) Who submits a completed medicaid application and all related, necessary verifications as contemplated at He-W 606, within 10 days;(4) Who undergoes a face-to-face clinical assessment by a registered nurse designated by the department's bureau of elderly and adult services (BEAS);(5) Who the department or qualified provider determines in accordance with He-W 619.02(b) is likely to be at risk of institutionalization without HCBC-ECI services;(6) Who the department determines is likely to be medicaid-eligible in accordance with He-W 619.02(c) ;(7) Who has not previously applied for or received PE coverage in the previous 12 months; and(8) Who acknowledges in writing his or her understanding and agreement that if the application is denied for any reason, the applicant shall be responsible for: a. The cost of services rendered after a determination of ineligibility; andb. The cost of services rendered during the presumptive eligibility period, if the department finds the application was filed with fraudulent intent. (b) Individuals shall be determined by the department or qualified provider to be at risk of institutionalization if: (1) Adult protective services has made a finding of abuse, neglect or exploitation and recommends home and community based care services because of a risk of institutionalization;(2) The individual is in a hospital, nursing facility or other medical facility, ready to be discharged, and the discharge planning team determines that the individual cannot be discharged home without supports in addition to those already available to him or her.(3) The individual has lost the assistance of a family or other caregiver, permanently or temporarily, whom the individual has depended on to meet his or her needs and no other alternatives are available; or(4) The individual does not have access to sufficient paid and/or unpaid supports that would enable the individual to safely maintain him or herself in the current home or community-based setting pending the routine eligibility determination process.(c) An individual who requests a presumptive eligibility determination shall be considered likely eligible for medicaid if the individual requires a nursing facility level of care and meets one of the following: (1) The individual is a medicaid recipient;(2) The individual was previously eligible for HCBC-ECI services but: a. The department closed the case due to an institutional stay of more than 30 days;b. There is no change in financial circumstances; andc. The individual is ready to return to the community;(3) The individual was previously eligible for HCB-ECI services but: a. The department closed the case due to a lump sum payment or other change in circumstances; andb. Such cause is no longer an impediment to eligibility;(4) The individual is a medicaid applicant who is age 65 or older, whose completed application indicates general and financial eligibility, and who does not benefit from a trust or annuity and has not transferred assets within the applicable lookback period as contemplated in He-W 620; or(5) The individual is a medicaid applicant aged 18 through 64 who is determined by the department to meet the standards for an expedited disability determination, presents a completed application that indicates general and financial eligibility, and who does not benefit from a trust or annuity and has not transferred assets within the applicable lookback period as contemplated in He-W 620.N.H. Admin. Code § He-W 619.02
#5171, eff 6-26-91; EXPIRED: 6-26-99
New. #9155, eff 5-10-08
Amended by Volume XXXVI Number 23, Filed June 9, 2016, Proposed by #11104, Effective 5/25/2016, Expires 11/21/2016.