Section He-E 801.26 - Residential Care Facility Services(a) The following residential care services shall be covered: (1) Those services described in He-P 804 or He-P 805; and(2) Transportation to medical services except when a course of prescribed treatment requires any of the following:a. Emergency transportation;b. Transportation more than once per week; orc. Transportation to a treatment location that is a greater distance from the facility than the participant's primary care physician.(b) Residential care facility services shall be covered when provided by facilities licensed in accordance with RSA 151:2 and either He-P 804 or He-P 805.(c) Reimbursement for all residential care facility services shall be included in one of 3 per diem rates in accordance with (d) below, established by the department in accordance with RSA 161:4, VI(a), and individual services shall not be reimbursed separately when provided in a residential care facility setting.(d) Residential care facilities licensed under He-P 804 shall be reimbursed at the base residential care facility rate, supported residential care facilities licensed under He-P 805 shall be reimbursed at different rates depending on the needs of the participant in accordance with (e) below.(e) Supported residential care facilities shall be reimbursed at the base residential care facility rate unless the supported residential care facility has qualified staff assess the needs of the participant using BEAS 3755, "Resident Level of Care Sheet" (January 2022).(f) Supported residential care facilities that complete BEAS 3755 shall be reimbursed a per diem rate based on the participant's needs as follows:(1) The base residential care facility rate for participants with needs assessed 0-8 on BEAS 3755;(2) Residential Care Dementia Level 1 for participants with needs assessed 9-17 on BEAS 3755; or(3) Residential Care Dementia Level 2 for participants with needs assessed 18-39 on BEAS 3755.N.H. Code Admin. R. He-E 801.26
(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 (formerly He-E 801.24).