Section He-M 522.15 - Allocation of Funds for Current and Future Individual Service Requests(a) All services covered by He-M 522 shall be provided to the extent that funds for this purpose are available and appropriated to the bureau by the Legislature.(b) For each applicant found eligible for Medicaid home- and community-based services, the area agency shall seek funding upon completion of the preliminary recommendation process pursuant to He-M 522.08. Unless the area agency makes a request for advanced crisis funding pursuant to (k) -(m) below, the bureau, subject to He-M 522.15(a) , shall allocate funding within 90 days of the preliminary service recommendation or within 90 days of start date requested by the individual or guardian, whichever is later.(c) For individuals who are already receiving Medicaid home- and community-based care services, if additional services are needed, the area agency shall request such funding and, subject to He-M 522.15(a) , the bureau shall approve it within 90 days of amendment of the individual service agreement or within 90 days of the start date requested by the individual, whichever is later, unless the area agency makes a request for advanced crisis funding pursuant to (k) -(m) below.(d) Each area agency shall maintain a projected service needs list for: (1) Individuals who: b. Do not require services currently; andc. Will need services later within the current or following fiscal years; and(2) Individuals who: a. Are receiving services; andb. Will need additional services later within the current or following fiscal years.(e) Each area agency shall maintain a wait list for those individuals for whom funding is not available in accordance with (a) above and who: (1) Do not qualify for services under (k) -(m) below; and(2) Either: a. Do not receive services but need and are ready to receive services; orb. Currently receive services and need and are ready to utilize additional services.(f) Each area agency shall include the following information on its wait list and projected service needs list: (1) The name and date of birth of the individual;(2) The diagnosis that identifies the individual's acquired brain disorder;(3) A brief description of the individual's circumstances and the services he or she needs;(4) The type and amount of services received, if any;(5) A preliminary estimate of cost;(6) The date by which services are needed; and(7) The date the individual's name went on the wait list or projected service needs list.(g) Each area agency shall report to the bureau quarterly: (1) On the wait list pursuant to (e) above; and(2) On the projected service needs list pursuant to (d) above.(h) To access the wait list funds appropriated for a given fiscal year, the area agency shall submit to the bureau a single list with the names of: (1) All individuals on its wait list; and(2) Those individuals on the projected service needs list who will be ready to receive services in that fiscal year.(i) In submitting its list pursuant to (h) above, the area agency shall prioritize each individual's standing on the list by determining the individual's urgency of need based on the following factors: (1) Current type or level of services does not provide the assistance and environment to meet all the individual's needs;(2) Declining health of the caregiver;(3) Declining health of the individual;(4) Individual with no day services while living with a caregiver;(5) Individual's low safety awareness;(6) Individual's behavioral challenges;(7) Individual's involvement in the legal system;(8) Individual living in or at risk of going to an institutional setting;(9) Significant regression in individual's overall skills such that the individual's level of independence is diminished; and(10) Length of time on the wait list as compared to others.(j) In maintaining its wait list and projected service needs list, the area agency shall exclude those circumstances where funds might be needed to cover additional expenditures, such as cost-of-living or other wage and compensation increases.(k) For individuals eligible for Medicaid home- and community-based care services or currently receiving such services, an area agency shall request advanced crisis funding to provide services without delay when there are no generic or area agency resources available and an individual is experiencing a significant life change pursuant to (l) below.(l) An individual shall be considered to be experiencing a significant life change if he or she is: (1) A victim of abuse or neglect pursuant to He-E 700 or He-M 202;(2) Abandoned and homeless;(3) Without a caregiver due to death or incapacitation;(4) At significant risk of physical or psychological harm due to decline in his or her medical or behavioral status; or(5) Presenting a significant risk to his or her own or the community's safety due to involvement with the legal system.(m) To demonstrate the need for advanced crisis funding, the area agency shall submit to the bureau, in writing, a detailed description of the individual's circumstances and needs and a proposed budget.(n) The bureau shall review the information submitted by the area agency and approve advanced crisis funding if it determines that one of the conditions cited in (l) above applies to the individual's situation.(o) For each request an area agency makes for funding individual services, the bureau shall make the final determination on the cost effectiveness of proposed services.N.H. Code Admin. R. He-M 522.15
#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.