N.H. Code Admin. R. He-M 522.12

Current through Register No. 21, May 23, 2024

Section He-M 522.12 - Service Agreements for Individuals Eligible for Medicaid Home- and Community-Based Care Services

(a) The service coordinator shall convene a meeting to prepare a service agreement in accordance with (b) -(f) below within 20 business days of the determination that funding for services for an individual.

(b) If people who provide services to the individual are not selected by the individual to participate in a service planning meeting, the service coordinator shall contact such persons prior to the meeting so that their input can be considered.

(c) Copies of relevant evaluations and reports shall be sent to the individual and guardian at least 5 business days before service planning meetings.

(d) Within 10 business days following a service planning meeting pursuant to (a) above, the service coordinator shall:

(1) Prepare a written service agreement that:

a. Includes the following:

1. A personal profile; and

2. A list of those who participated in the service planning agreement meeting; and

b. Describes the following:

1. The specific support services to be provided under each service category;

2. The goals to be addressed, and timelines and methods for achieving them;

3. The persons responsible for implementing the service agreement;

4. Services needed but not currently available;

5. Any training needed to carry out the service agreement, beyond the staff training required by He-M 506.05 and other applicable rules, with the type and amount of such training to be determined by the service agreement participants;

6. Service documentation requirements sufficient to describe progress on goals and the services received;

7. If applicable, reporting mechanisms under self-directed services regarding budget updates and individual and guardian satisfaction with services; and

8. The individual's need for guardianship, if any;

(2) Contact all persons who have been identified to provide a service to the individual and confirm arrangements for providing such services; and

(3) Explain the service arrangements to the individual and guardian and confirm that they are to the individual's and guardian's satisfaction.

(e) Within 5 business days of completion of the service agreement, the area agency shall send the individual or guardian the following:

(1) A copy of the service agreement signed by the area agency executive director or designee;

(2) The name, address, and phone number of the service coordinator or service provider(s) who may be contacted to respond to questions or concerns; and

(3) A description of the procedures for challenging the proposed service agreement pursuant to He-M 522.19 for those situations where the individual or guardian disapproves of the service agreement.

(f) The individual or guardian shall have 10 business days from the date of receipt of the service agreement to respond in writing, indicating approval or disapproval of the service agreement. Unless otherwise arranged between the individual or guardian and the area agency, failure to respond within the time allowed shall constitute approval of the service agreement.

(g) When a service agreement has been approved by the individual or guardian and area agency director, the services shall be implemented and monitored as follows:

(1) A person responsible for implementing any part of a service agreement, including goals and support services, shall collect and record information about services provided and summarize progress as required by the service agreement or, at a minimum, monthly;

(2) On at least a monthly basis, the service coordinator shall visit or have verbal contact with the individual or persons responsible for implementing a service agreement and document these contacts;

(3) The service coordinator shall visit the individual and contact the guardian, if any, at least quarterly, or more frequently if so specified in the individual's service agreement, to determine and document:

a. Whether services match the interests and needs of the individual;

b. Individual and guardian satisfaction with services; and

c. Progress on the goals in the service agreement; and

(4) If the individual receives services under He-M 1001, He-M 521, or other residential licenses under RSA 151:2, I (e), at least 2 of the service coordinator's quarterly visits with the individual shall be in the home where the individual resides.

(h) The service coordinator and a licensed nurse shall visit the individual within 5 days of relocation to a new residence or change in a residential provider to:

(1) Determine if the transition has resulted in adverse changes in the health or behavioral status of the individual; and

(2) Develop and document a plan to remediate any issues, if negative changes are noted.

(i) Service agreements shall be renewed at least annually.

N.H. Code Admin. R. He-M 522.12

#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.