Section He-E 801.03 - Eligibility(a) An individual shall be eligible to receive CFI waiver services if he or she meets all of the following requirements:(1) Submission of a signed and dated application, as defined in He-W 601.01(p), to the department;(2) Is at least 18 years of age;(3) Meets the financial and categorical requirements for medicaid;(4) Meets the clinical eligibility requirements for nursing facility care in RSA 151-E:3, I(a), namely, the person requires 24-hour care for one or more of the following purposes, as determined by skilled professional medical personnel: a. Medical monitoring and nursing care when the skills of a licensed medical professional are needed to provide safe and effective services;b. Restorative nursing or rehabilitative care with patient-specific goals;c. Medication administration by oral, topical, intravenous, intramuscular, or subcutaneous injection, or intravenous feeding for treatment of recent or unstable conditions requiring medical or nursing intervention; ord. Assistance with 2 or more ADLs;(5) Requires the provision of at least one of the CFI waiver services pursuant to He-E 801.12, as documented in the identified needs list, and receives at least one of the CFI waiver services monthly; and(6) Has chosen, or whose legal representative has chosen, by signing the application in (1) above, CFI waiver services as an alternative to institutional care.(b) Pursuant to 42 CFR 441.301 (b)(1)(iii) and (b)(6), eligibility shall be restricted to individuals who meet the target population criteria approved by the centers for medicare and medicaid services (CMS) for the CFI waiver program and who, without the CFI waiver services, would require the level of care provided in a nursing facility as described in He-E 802.(c) While receiving care as a resident in a nursing facility, an individual shall not be eligible for coverage of CFI waiver services listed in He-E 801.12 except for targeted case management in accordance with RSA 151-E:17.(d) An individual shall not be considered to be a resident of a nursing facility in (c) above if he or she is a CFI participant who is admitted to a nursing facility on a temporary basis for treatment or care for an acute episode.(e) For those CFI participants who are receiving short-term inpatient care in a hospital or nursing facility, the following shall apply:(1) Services described in He-E 801.12(d) shall not be provided while the participant is in the facility, except for services that have been prior authorized for the purpose of enabling the participant to transition back to his or her community and targeted case management in accordance with RSA 151-E:17; and(2) The participant's clinical eligibility shall be maintained until such time that an eligibility redetermination is conducted in accordance with He-E 801.07 and the participant is determined ineligible.N.H. Code Admin. R. He-E 801.03
(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11
Amended by Volume XXXIX Number 32, Filed August 8, 2019, Proposed by #12830, Effective 8/7/2019, Expires 2/3/2020.Amended by Volume XLII Number 6, Filed February 10, 2022, Proposed by #13340, Effective 1/29/2022, Expires 1/29/2032.