N.H. Admin. Code § He-M 1302.13

Current through Register No. 45, November 7, 2024

Section He-M 1302.13 - Resident Reviews

(a) Whenever there has been a significant change in the physical or mental condition of an individual with MI or DD:

(1) The nursing facility shall report the change to the PASRR office; and

(2) The PASRR office shall perform a resident review by:

a. Confirming there has been a significant change; and

b. If there has been a significant change, conducting a level II evaluation and determination.

(b) "Significant change" means when an individual's mental or physical condition has declined or improved such that the change:

(1) If a decline, will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions;

(2) Impacts more than one area of the resident's health status; and

(3) Requires interdisciplinary review or revision of the plan of care, or both.

(c) Upon completion of a resident review, the PASRR office shall convey the findings to the individual and his or her legal representative pursuant to He-M 1302.12.

(d) The resident review shall include one of the following determinations regarding continued placement for individuals with MI or DD:

(1) Any individual who does not require nursing facility services and does not need specialized services shall be discharged from the nursing facility;

(2) Any individual who requires the services provided by a nursing facility and is currently receiving such services shall continue to receive services if he or she chooses;

(3) An individual shall be offered specialized services and may choose to move to community living or continue to reside in the facility if he or she:

a. Has resided in a nursing facility at least 30 consecutive months prior to the review date;

b. Does not require the services provided by a nursing facility; and

c. Requires specialized services; and

(4) An individual shall be discharged from the nursing facility if he or she:

a. Has resided in a nursing facility less than 30 consecutive months prior to the review date; and

b. Does not require the services provided by a nursing facility; and

c. Needs specialized services.

(e) The resident review shall also specify service determinations and related actions documenting the need for the continuation of specialized services, if applicable.

(f) For the purpose of establishing length of stay in nursing facilities, the 30 months of continuous residence referenced in (d) (3) -(4) above shall:

(1) Be calculated back from the date of the first resident review determination which finds that the individual is not in need of nursing facility services; and

(2) Include temporary absences and consecutive residences in more than one nursing facility.

N.H. Admin. Code § He-M 1302.13

#10216, eff 10-29-12 (from He-M 1302.10 )