N.H. Admin. Code § He-W 652.07

Current through Register No. 50, December 12, 2024

Section He-W 652.07 - Developing Potential Sources of Income

(a) "Finding of clinical ineligibility" means any denial or termination of federal cash benefits:

(1) Due to not meeting the medical disability criteria; and

(2) In response to an application, reapplication, or appeal filed for federal cash benefits.

(b) To be eligible for FANF or adult category financial assistance an individual shall have applied for all potential sources of income or benefits including, but not limited to:

(1) Benefits described under Title XVI of the Social Security Act;

(2) Benefits described under Title II of the Social Security Act;

(3) Veteran's benefits, including the veteran's affairs aid and attendance allowance;

(4) Retirement benefits or pensions;

(5) Disability benefits or pensions;

(6) Unemployment or worker's compensation;

(7) Contributions from any liable third-party; and

(8) Third-party medical coverage.

(c) The application for other benefits described in (b) above, shall be made:

(1) Prior to the department initiating a determination of eligibility for the adult category financial assistance program; or

(2) If applying for FANF, no later than 30 days after the referral for those benefits were made.

(d) If the individual is incapable of applying for the aid and attendance allowance pursuant to (b)(3) above, does not have an authorized representative to apply on the individual's behalf, and the nursing facility will not apply on the individual's behalf, the eligibility worker shall initiate the application for the aid and attendance allowance on the individual's behalf.

(e) When applying for the benefits described in (b) above, applicants and recipients of FANF or adult category financial assistance shall:

(1) Provide all required information and verification and complete all forms as required in the application process for the other benefit;

(2) Cooperate in taking all necessary steps to obtain the other income or benefit;

(3) Accept the other income or benefit if eligible; and

(4) Pursue all appeal options within the timeframes set by the eligibility-determining agencies or individuals responsible for the other benefits described in (b) above, up to, but not including, court action, if found ineligible for the benefit due to medical reasons.

(f) Financial assistance for the entire assistance group shall be terminated or denied if an individual is ineligible for the other benefits described in (b) above, due to refusal or failure to:

(1) Complete the application process for the other benefit;

(2) Provide information or verification to obtain the benefits described in (b) above;

(3) Cooperate with the eligibility-determining agencies or individuals responsible for the other benefits described in (b) above;

(4) Meet the application timeframes described in (c) above or set by the eligibility-determining agencies or individuals responsible for the other benefits described in (b) above;

(5) Pursue all appeal options in accordance with (f)(2) above; or

(6) Accept the benefit if eligible.

(g) To be eligible for APTD financial assistance and pursuant to RSA 167:6,VI, APTD financial assistance applicants and recipients who have received a finding of clinical ineligibility shall provide the department with the following:

(1) Written notification from the federal agency which indicates the date and reason the individual was denied federal cash benefits within:

a. Thirty calendar days from the date of application for adult category financial assistance for any finding of clinical ineligibility received prior to the APTD financial assistance application, provided the finding of clinical ineligibility was made not more than 12 months prior to the date of application; and

b. Ten calendar days from the date on the notice of any finding of clinical ineligibility after the date of APTD financial application; and

(2) Written notification from the federal agency that denied the benefits which verifies that the APTD applicant or recipient is appealing the denial or has reapplied for federal benefits within 30 calendar days of having received a finding of clinical ineligibility for federal benefits.

(h) To be eligible for APTD financial assistance once APTD financial assistance has been terminated or denied due to a finding of clinical ineligibility, the individual shall:

(1) File a new application;

(2) Meet all APTD program eligibility requirements; and

(3) Meet all the requirements in (i) below.

(i) If APTD financial benefits were terminated or denied:

(1) Due to being denied federal cash benefits due to a finding of clinical ineligibility, the individual shall provide proof that the individual is now approved for federal cash benefits; or

(2) Due to failure to provide notification of clinical ineligibility decision or appeal of clinical ineligibility decision pursuant to (g) above, the individual shall:

a. Provide all the required proof; and

b. Demonstrate via the proof provided that the federal financial cash benefits denials and subsequent appeals of the denials, were not due to a finding of clinical ineligibility.

(j) If an individual is eligible for APTD financial assistance pursuant to (h) above, APTD financial assistance shall begin the next semi-monthly payment period following the date all the requirements in (i) are met.

(k) To be eligible for continued receipt of APTD financial assistance pending the decision on the administrative appeal after an individual's APTD financial assistance is terminated due to a finding of clinical ineligibility the individual shall:

(1) Appeal the decision within 10 days from the date on the notice of decision; and

(2) Provide documentation:

a. Dated and signed by a physician, physician's assistant (PA), advanced practice registered nurse (APRN), or psychologist which includes:

1. The printed name of the health professional signing the documentation;

2. The specialty of the health professional; and

3. The address and phone number of the health professional; and

b. That states the individual's medical condition and that the medical condition:

1. Has increased in severity within the last 12 months; or

2. That was used when applying for or appealing the federal benefits is unrelated to the medical condition for which the individual applied for APTD financial assistance.

(l) Applicants denied cash assistance due to a finding of clinical ineligibility that have not started receiving cash benefits are not eligible for continued receipt of benefits pending appeal pursuant to (k) above.

(m) If the department's termination of APTD financial assistance is overturned at the appeals hearing due to the circumstances described in (k) above, the individual shall provide the department with written notification from the federal agency that the individual has:

(1) Appealed the federal denial received if the individual appealed the department's decision based on (k)(2)b.1. above; or

(2) Reapplied for federal benefits for the same medical condition for which the individual applied for APTD financial assistance if the individual appealed the department's decision based on (k)(2)b.2. above.

(n) The amount of all APTD financial assistance provided to the individual during the pendency of the appeal is subject to recoupment, in accordance with He-W 692, if the administrative appeal does not find in favor of the individual.

N.H. Admin. Code § He-W 652.07

(See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #5749, INTERIM, eff 12-1-93, EXPIRED: 3-31-94; amd by #5806, eff 3-30-94; ss by #6531, INTERIM, eff 6-27-97, EXPIRED: 10-25-97; ss by #6614, eff 10-24-97; ss by #7913, eff 6-26-03; ss by #9893, eff 6-26-11; amd by #10374, eff 7-12-13

Amended by Volume XXXIX Number 32, Filed August 8, 2019, Proposed by #12829, Effective 7/20/2019, Expires 1/16/2020.

Amended by Volume XL Number 46, Filed November 12, 2020, Proposed by #13121, Effective 10/21/2020, Expires 10/21/2030