Section He-M 522.11 - Service Planning for Individuals Eligible for Medicaid Home- and Community-based Care Services(a) Once funding is identified for an individual, the service coordinator shall facilitate service planning to develop a service agreement in accordance with He-M 522.12.(b) The service planning shall: (1) Be a personalized and ongoing process to plan, develop, review, and evaluate the individual's services in accordance with the criteria set forth in He-M 522.09;(2) Include identification by the individual or guardian and the individual's service providers of those services and environments that will promote the individual's health, welfare, and quality of life; and(3) Include information obtained through utilization of the Supports Intensity Scale (SIS), which shall be administered for each individual: a. Upon determination of the individual's eligibility; andb. Either: 1. Every 5 years thereafter; or2. When there is a significant life change in the individual's status or condition, as described in He-M 522.15(l) .(c) The service coordinator shall, as applicable, maximize the extent to which an individual participates in and directs his or her service planning process by: (1) Explaining to the individual the service planning process and assisting the individual to determine the process within the scope of He-M 522;(2) Explaining to the individual his or her rights and responsibilities;(3) Eliciting information from the individual regarding his or her personal preferences and service needs, including any health concerns, that shall be a focus of service planning meetings;(4) Determining with the individual issues to be discussed during service planning meetings; and(5) Explaining to the individual the limits of the decision-making authority of the guardian, if applicable, and the individual's right to make all other decisions related to services.(d) The individual or guardian may determine the following elements of the service planning process: (1) The number and length of meetings;(2) The location, date, and time of meetings;(3) The meeting participants; and(4) Topics to be discussed.(e) In order to develop or revise a service agreement to the satisfaction of the individual or guardian, the service planning process shall consist of periodic and ongoing discussions and meetings that: (1) Include the individual and other persons involved in his or her life;(2) Are facilitated by a service coordinator; and(3) Are focused on the individual's abilities, health, interests, and achievements.(f) The service planning process shall include a discussion of the need for guardianship. The area agency director shall implement any recommendations concerning guardianship contained in the service agreement.(g) The service planning process shall include a discussion of the need for assistive technology that could be utilized to support any services or activities identified in the proposed service agreement regardless of the individual's current use of assistive technology.(h) Service agreements shall be reviewed by the service coordinator with the individual or guardian at least once during the first 6 months of service and, thereafter, as needed. The annual review required by He-M 522.10(b) (8) shall include a service planning meeting.(i) The individual or guardian may request, in writing, a delay in an initial or annual service agreement meeting. The area agency shall honor this request.(j) The service coordinator shall be responsible for monitoring services identified in the service agreement and for assessing individual, family, or guardian satisfaction at least annually for basic service agreements and quarterly for service agreements.(k) An area agency director, service coordinator, service provider, individual, guardian, or individual's friend shall have the authority to request a service agreement meeting when: (1) The individual's responses to services indicate the need;(2) A change to another service is desired;(3) A personal crisis has developed for the individual;(4) The individual has experienced a significant life change; or(5) A service agreement is not being carried out in accordance with its terms.(l) At a meeting held pursuant to (k) above, the participants shall: (1) Document whether and how to modify the service agreement; and(2) Identify any service needs, including those due to a significant life change, that are not currently funded.(m) Service agreement amendments may be proposed at any time. Any amendment shall be made with the consent of the individual or guardian and the area agency.(n) Service agreement amendments made as a result of a significant life change shall be implemented with the individual's or guardian's written approval except by mutual agreement between the area agency and the individual specifying a time limited extension.(o) If the individual, guardian, or area agency director disapproves of the service agreement, the dispute shall be resolved by one or more of the following: (1) Informal discussions between the individual or guardian and service coordinator;(2) Reconvening a service planning meeting; or(3) The individual or guardian filing an appeal to the bureau pursuant to He-C 200.N.H. Code Admin. R. He-M 522.11
#7120, eff 10-20-99; ss by #8974, INTERIM, eff 10-6-07, EXPIRED: 4-3-08
New. #9734, eff 6-25-10
The amended version of this section by New Hampshire Register Volume 38, Number 50, eff. 11/30/2018 is not yet available.