Section He-M 503.05 - Determination of Eligibility(a) To determine the existence of an applicant's developmental disability, the area agency shall perform a comprehensive screening evaluation consisting of: (1) Reviewing available information, including, but not limited to:a. Birth, developmental, and educational histories;b. Current physical, intellectual, cognitive, and behavioral evaluations;c. An age-appropriate standardized functional assessment; andd. As applicable, additional specialty medical, health, or clinical evaluations, such as communication, functional behavior, psychological, or psychopharmacological assessments, assistive technology, and personal safety or comprehensive risk assessments; and(2) Gathering additional information and performing the additional evaluations among those listed in (1) above that are necessary to complete the determination, if the information available is not adequate to make a determination of eligibility.(b) The results of the comprehensive screening evaluation pursuant to (a) above and any other information concerning the applicant's disability shall be the basis for determination of eligibility pursuant to He-M 503.03 and assist in the identification of needs and provision of services.(c) To the extent possible, the area agency shall utilize generic resources to pay for an applicant's comprehensive screening evaluation. Such resources shall, with the applicant's consent, include private and public insurance.(d) An area agency shall review the information it has received regarding an applicant and, within 15 business days after the receipt of the completed application, make and communicate one of the following decisions on the eligibility of the applicant in accordance with He-M 503.03 to the applicant, guardian, or representative: (2) Conditionally eligible pursuant to He-M 503.02(l); or(e) If an area agency determines additional information is necessary in order to make a determination in accordance with (d) above, a communication detailing the additional information necessary shall be provided to the applicant, guardian, or representative, and the application shall not be determined complete until all necessary information has been received by the area agency.(f) In cases where the information on eligibility is inconclusive, the area agency may consult with the bureau regarding determination of eligibility prior to making a decision in accordance with (d) above.(g) Decisions by the bureau in (f) above shall be made within 5 business days.(h) In instances where consultations in (f) above would cause the area agency's decision pursuant to (d) above to exceed 15 business days, an additional 7 business days shall be allowed to make such decision.(i) A written denial of eligibility pursuant to (d)(3) above, shall describe the specific legal and factual basis for the denial, including specific citation of the applicable law or department rule, and advise the applicant of the appeal rights under He-M 503.16.(j) Following denial of eligibility, the applicant, guardian, or representative, as applicable, may reapply for services if new information regarding the diagnosis, age of onset, or severity of the disability becomes available.(k) Communication of approval or conditional eligibility in accordance with (d)(1) or (2) above shall include a contact person at the area agency.(l) Preliminary planning to determine the services needed shall occur with the individual and guardian, or representative at the time of intake or during subsequent discussions. Preliminary evaluations shall be completed and preliminary recommendations for services shall be made within 21 days of a completed application for service.(m) Within 3 days of the determination of an applicant's eligibility under He-M 503.05(d)(1) or (2), an area agency shall review 1915(c) of the Social Security Act, home and community-based waiver services with the individual, guardian, or representative in order to make a decision.(n) If the individual, guardian, or representative is interested in pursuing home and community-based waiver services within the next 12 months, within 5 business days of the individual's decision pursuant to (m) above, the area agency shall submit an application for waiver level of care eligibility pursuant to He-M 517.03 to the bureau.(o) The bureau shall review an application submitted pursuant to (n) above and make a decision within 15 business days of receipt of the application.(p) Within 3 days of the decision, the bureau shall communicate the decision to the area agency and the individual, guardian, or representative in writing.(q) If the bureau determines the individual is not eligible for services in He-M 517, the notice shall include the specific legal and factual basis for the determination, including a specific citation to the applicable law or department rule, and the bureau shall advise the individual, guardian, or representative in writing of the appeal rights under He-M 517.09.(r) If there is not sufficient information to determine the individual's level of care, a request for additional information shall be sent by the bureau to the submitting entity to allow an additional 10 days to provide information sufficient to determine level of care.(s) If information to determine is not provided, the bureau shall deny the level of care application, however, if new information becomes available after such denial, a new application may be submitted.(t) Pursuant to RSA 171-A:6, IV, in an emergency situation, temporary service arrangements may be made prior to the completion of the evaluation in (a) above if the bureau administrator, or designee, first determines that the individual meets one of the following: (1) Is a victim of abuse or neglect pursuant to He-E 700;(2) Is abandoned and homeless;(3) Is without a caregiver due to death or incapacitation;(4) Is at significant risk of physical or psychological harm due to decline in their medical or behavioral status; or(5) Is presenting a significant risk to community safety.(u) The determination of eligibility by one area agency, pursuant to He-M 503.05(d), shall be accepted by every other area agency in the state.N.H. Admin. Code § He-M 503.05
#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07
Amended byVolume XXXV Number 06, Filed February 12, 2015, Proposed by #10774, Effective 1/27/2015, Expires7/27/2015.Amended by Volume XXXV Number 32, Filed August 13, 2015, Proposed by #10900, Effective 7/25/2015, Expires7/25/2025.Amended by Number 2, Filed January 11, 2024, Proposed by #13841, Effective 12/29/2023, Expires 12/29/2033.