Section He-E 805.02 - Definitions(a) "Activities of daily living" means those activities associated with personal care, including personal hygiene, bathing, eating, dressing, toilet use, walking, transferring from one surface to another, moving between locations, and bed mobility.(b) "Biopsychosocial history" means information about a participant's past and present functioning in the areas of: (2) Psychological health, including emotional/coping ability;(3) Decision-making ability;(4) Social environment, including interactive skills, activities and supports;(5) Family relationships;(6) Financial considerations;(8) Any vocational interests and activities, including spiritual preferences; and(9) Any other area of significance in the participant's life, including, but not limited to, substance abuse or misuse, involvement with the behavioral health care system, developmental disability system, or legal system.(c) "Case management agency" means an agency that is licensed in accordance with RSA 151:2, I(b) , and enrolled as a New Hampshire medicaid provider to provide targeted case management services to CFI participants, and that operates without a conflict of interest. This term includes independent case management agencies.(d) "Case manager" means an individual employed by, or contracted with, a case management agency who: (1) Meets the qualifications described in He-E 805.06;(2) Is responsible for the ongoing assessment, person-centered planning, coordination, and monitoring of the provision of services included in the comprehensive care plan; and(3) Does not have a conflict of interest.(e) "Complaint" means: (1) Any allegation or assertion that a right of a participant has been violated;(2) Any allegation or indication that an individual has been abused, neglected, or exploited by an employee of, or a volunteer or consultant for, a facility, provider, or program; or(3) Any allegation or assertion that the department or a facility, agency, or service provider has acted in an illegal or unjust manner with respect to a participant or category of participants.(f) "Comprehensive assessment" means a person-centered process of gathering information about a participant's abilities and needs through a face-to-face interview with the participant, and other methods as needed, which culminates in a written document.(g) "Comprehensive care plan" means an individualized plan described in He-E 805.05(c) that is the result of a person-centered process that identifies the strengths, capacities, preferences, and desired outcomes of the participant.(h) "Conflict of interest" means a conflict between the private interests and the official or professional responsibilities of a person, such as providing other direct services to the participant, being the guardian of the participant, or having a familial or financial relationship with the participant.(i) "Department" means the New Hampshire department of health and human services.(j) "Home and community-based care for the elderly and chronically ill (Choices for Independence) " means a system of long-term care services provided in non-institutional settings and described in He-E 801, and provided under a waiver of Section 1902(a) (10) and 1915(c) of the Social Security Act for participants who are elderly or adults who have a disability or chronic illness.(k) "Incident" means an occurrence or event that interrupts normal procedure, including a serious injury or other event threatening the health or safety of a participant or staff.(l) "Individualized contingency plan" means the person-centered plan that addresses unexpected situations that could jeopardize the participant's health or welfare, and which: (1) Identifies alternative staffing resources in the event that normally scheduled care providers are unavailable; and(2) Addresses special evacuation needs that require notification of the local emergency responders.(m) "Instrumental activities of daily living" means those activities associated with home management, including grocery shopping, meal preparation, telephone use, and managing finances, and routine housework such as washing dishes, making beds, dusting, and laundry.(n) "Medical eligibility assessment (MEA) " means an initial assessment and subsequent re-assessments conducted in accordance with RSA 151-E:3, I.(o) "MEA needs list/support plan" means a document generated by the department that identifies participant needs to be addressed in the comprehensive care plan.(p) "Participant" means an individual who has been found by the department to be eligible for the CFI program.(q) "Person-centered" means a process for planning and supporting the participant receiving services that builds upon the participant's capacity to engage in activities that promote community life and honors the participant's preferences, choices, and abilities, and which involves families, friends, and professionals as the participant desires or requires.(r) "Sentinel event" means an unexpected occurrence, including: (1) The death of a participant from suicide or homicide; or(2) A serious physical or psychological injury, or risk thereof, resulting from: b. An unauthorized departure from a facility;c. A medication error which results in paralysis, coma, permanent loss of function, or death;d. A delay in the provision of departmental services resulting in a negative outcome; ore. Abuse and/or neglect that results in paralysis, coma, permanent loss of function, or death, of a participant who: 1. Is receiving department funded services;2. Has received department funded services within the preceding 30 days; or3. Has been evaluated by a contract provider within the preceding 30 days.(s) "Targeted case management" means the collaborative process of assessment, planning, facilitation, advocacy, coordination, and monitoring that is accomplished with a person-centered process, and which: (1) Assists participants to gain access to needed CFI waiver services, services contained in the medicaid state plan, and other medical, social, spiritual, vocational, educational, and community supports, regardless of the funding source; and(2) Provides for coordination of participant service plans from all providers to assure adequacy and, appropriateness of care and cost effectiveness of planned services that yield positive outcomes.N.H. Code Admin. R. He-E 805.02
Amended by Volume XXXVI Number 36, Filed September 8, 2016, Proposed by #11167, Effective 8/25/2016, Expires 2/21/2017.Amended by Volume XXXVII Number 10, Filed March 9, 2017, Proposed by #12115, Effective 2/22/2017, Expires 2/22/2027.