Section He-E 806.36 - Rate Setting and Payment Limitations for Atypical Nursing Care(a) A provider of atypical care shall be a NF or a distinct part of a NF which possesses the physical characteristics and appropriate staffing for, and devotes its services exclusively to, highly specialized care, the nature of which renders that NF or unit incomparable to other NF's for the purpose of calculating and applying cost and/or occupancy limits.(b) Examples of such care described in (a) above shall include services for: (1) Children with severe physical or mental disabilities;(2) Brain/spinal injured patients;(3) Ventilator dependent patients; or(4) Other specialized services.(c) The department shall determine the rate of reimbursement utilizing cost documentation submitted by the NF provider which clearly identifies the cost of the atypical care.(d) The rate described in (c) above shall: (1) Include routine care costs, ancillary costs and capital costs;(2) Take into consideration any additional amount necessary to assure access to necessary and appropriate services for NH Medicaid residents with specialized care needs; and(3) Be exempt from comparative cost and occupancy limits.(e) In order to qualify as a provider of atypical care a NF provider shall make application in writing which: (1) Requests to be considered a provider of atypical care;(2) Describes the care or services to be provided; and(3) Documents the costs of such care.(f) The department shall determine if a NF is qualified to provide and be paid for atypical care based on documentation submitted by the NF, and on whether there is a documented need for these services as determined by the availability of such services in the locality.(g) Applications for approval of atypical care providers which have been denied may be appealed pursuant to He-E 806.41.N.H. Code Admin. R. He-E 806.36
#8547, eff 1-24-06 (formerly He-W 593.38 )