Section He-E 801.06 - Service Authorization(a) Upon review of the information provided in He-E 801.05(c) and within 6 business days, the department shall authorize services that meet the needs identified in the clinical assessment in He-E 801.04(a) and other later established needs.(b) Service authorizations shall include specific types, units, and frequencies of the needed services.(c) Service authorizations shall be issued to specific service providers identified by the participant and his or her case manager as a result of person-centered planning.(d) When the service authorization does not include all the services requested, the participant shall be sent a notice, to include:(1) The requested service;(2) The authorized service;(3) A statement regarding the reason and legal basis for the denial;(4) Information regarding the participant's option to request reconsideration pursuant to (e) below; and(5) Information concerning the participant's right of appeal pursuant to He-C 200, including the requirement that the participant has 30 calendar days from the date of the notice authorizing services to file such an appeal.(e) A participant who disagrees with a denial of a service authorization may request a reconsideration of the service authorization, as follows:(1) The participant, or his or her representative, shall submit a written request to the department within 30 days of the service authorization; and(2) The written request shall include an explanation of the reason why a specific service authorization should be changed, including any supporting documentation.(f) The department shall review the request in (e) above and provide a written notice to the participant, or his or her representative, of its decision based on the criteria for applicable service authorization to maintain or change the original service authorization, including the reason therefor.(g) Requesting a service authorization reconsideration shall not: (1) Preclude in any way a participant's right to appeal a disputed service authorization in accordance with He-C 200;(2) Change the timeframes established for filing an appeal; and(3) Affect the amount or type of services authorized.N.H. Code Admin. R. He-E 801.06
(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.