Section He-E 803.08 - Payment for Services(a) Adult medical day services described He-E 803.06(a) shall be reimbursed: (1) At a daily rate for all services provided, except for specialized transportation described in He-E 803.03(a) (7) c. and He-E 803.06(b) , which shall be reimbursed in accordance with (b) below; and(2) Only for days when the participant was in attendance at the adult medical day program for a minimum of 4 hours exclusive of time spent in transit or was receiving services not included in the per diem rate.(b) Adult medical day programs providing specialized transportation, as described in He-E 803.03(a) (7) c. and He-E 803.06(b) , shall be reimbursed at a per-person, per-trip rate.(c) Rates of payment for services described in (a) and (b) above shall be established by the department in accordance with RSA 161:4, VI(a) .(d) Transportation shall not be reimbursed when it is covered by other Medicaid reimbursement for transportation.(e) Adult medical day programs shall submit all initial claims to the Medicaid fiscal agent, so that the fiscal agent receives the claims no later than one year from the earliest date of service on the claim.(f) If an adult medical day program has submitted a claim during the one-year billing period, and the claim is subsequently rejected by the fiscal agent, the adult medical day program shall resubmit the claim within 15 months from the earliest date of service if the adult medical day program still wishes to receive reimbursement.(g) Adult medical day programs participating in the Medicaid program shall be responsible for timely and accurate billing as required above, and the adult medical day program shall not bill the participant if Medicaid does not pay due to billing practices of the adult medical day program which result in non-payment for a Medicaid item, supply or service.N.H. Code Admin. R. He-E 803.08
#7865, eff 5-1-03; ss by #9914, INTERIM, eff 5-1-11, EXPIRES: 10-28-11; ss by #10010, eff 10-28-11 (from He-E 803.09 )