N.H. Admin. Code § He-M 505.03

Current through Register No. 45, November 7, 2024

Section He-M 505.03 - Role and Responsibilities of the Area Agency

(a) The primary responsibility of an area agency, designated in accordance with He-M 505, shall be to plan, establish, or maintain comprehensive service access and delivery for all individuals who are residing in the area, in accordance with RSA 171-A and the rules promulgated thereunder, by:

(1) Maintaining a current contract with the department to serve as an area agency;

(2) Managing and providing family support services in accordance with He-M 519;

(3) Managing and providing family centered early supports and services in accordance with He-M 510;

(4) Providing or supporting the arrangement of financial management services for individuals who choose to direct and manage their waiver services;

(5) Managing and completing intake and eligibility activities for individuals in order to determine access to the developmental services system in accordance with He-M 503 and He-M 522 and to facilitate and assist individuals in applying for and maintaining Medicaid benefits;

(6) Developing and managing initial service planning and access to supports for individuals found to be eligible for services pursuant He-M 503, He-M 522, or He-M 524;

(7) Providing oversight and management of the provider network by:

a. Coordinating and monitoring the provider network to support the needs of the catchment region as outlined in the agency's area plan, developed pursuant to He-M 505.04(p);

b. Communicating relevant service delivery system updates to provider agencies and provide training as needed;

c. Monitoring current service capacity using data from the bureau to identify risk and solutions;

d. Reporting to the bureau quarterly, the results from monitoring in c. above and follow up on actions taken pursuant to f. below, to support provider network management;

e. Promoting the establishment of new provider agencies to increase service capacity as determined by the bureau based on the data provided in d. above; and

f. Providing follow-up to the bureau on actions taken in accordance with e. above;

(8) Providing information, education, and referrals to the service delivery system, as defined in RSA 171-A:2, XVI, by:

a. Providing objective information and assistance that empowers people to make informed decisions about their services and supports; and

b. Networking and partnering with community organizations with the goal of supporting inclusive community life, leveraging natural resources, services, and supports, and in improving the community's understanding of the service delivery system;

(9) Managing registry documentation by:

a. Assisting individuals in the determination of and documentation of need for services to be provided, pursuant to He-M 503, within 5 years from the date of initial eligibility; and

b. Reviewing and updating the registry as early as practicable anytime a need for services in the next 5 years is identified;

(10) Submitting level of care submissions to the bureau in accordance with He-M 517 and He-M 524 for initial level of care determinations as well as level of care determinations for transfers between home and community based services waivers;

(11) Initiating waiver services in accordance with He-M 503, He-M 522, and He-M 524 including:

a. Facilitating the scheduling of an individual's initial supports intensity scale assessment for individuals who do not have a service coordinator;

b. Providing resources to an individual regarding service coordination agencies so the individual can select a service coordination provider; and

c. Following bureau approval of level of care in accordance with He-M 503.05, submission of the individual's selection in accordance with b. above to NH Easy for provider review and acceptance;

(12) Maintaining and updating records in the electronic database NH Easy at;

(13) Completing service utilization and quality oversight by:

a. Managing service agreement development through monthly monitoring of annual service agreement renewals;

b. Reviewing service agreements quarterly and communicating any identified needs to applicable service provider agencies;

c. Managing and overseeing submission of out-of-state service provision requests to the bureau;

d. Monitoring provision of services as prescribed in the service agreement by:

1. Completing annual service and post-payment audits using a tool provided by the bureau within 60 days of request by the bureau; and

2. Providing results of the audits completed in accordance with (1) above to include raw data, aggregated data, and analysis of findings;

e. Assessing annual satisfaction with quality of services, and reviewing and continuously improving quality of services by:

1. Soliciting feedback from individuals and families within the agency's geographic region; and

2. Providing results of the feedback received in accordance with (1) above to include raw data, aggregated data, and analysis of findings;

f. Completing inquiry and review at the request of the bureau related to service concerns, complaints, or grievances;

g. Ensuring training and education dissemination related to identified trends of sentinel events, restraint and seclusion, and mortality. Area agencies shall ensure that at least one training per state fiscal year quarter is offered and provided to those who register;

h. Collaborating with the community mental health center that serves the region to support coordinated service planning and delivery for individuals accessing or wishing to access services from both service systems; and

i. Collaborating with the regional public health network that serves the region to support emergency planning processes in order to develop and execute response and recovery plans;

(14) Increasing access to employment by:

a. Acting on employment trends, as identified by the bureau; and

b. Participating in the employment leadership committee pursuant to He-M 518;

(15) Providing critical incident management by:

a. Collecting restraint and seclusion data and providing such data to the bureau quarterly with analysis of findings on a tool approved by the bureau;

b. Finalizing mortality notifications and reviews received from provider agencies and submitting these reviews to the bureau;

c. Finalizing sentinel event reports and submitting these reports to the bureau;

d. Reviewing reports of incidents to determine if a sentinel event report is needed;

e. Monitoring follow-up related to findings from formal complaint investigations conducted pursuant to He-M 202;

f. Providing coordination, logistical support, and subject matter expertise to service coordinators regarding crisis mitigation situations;

g. Providing crisis data to the bureau quarterly with analysis of any observed findings on a tool approved by the bureau;

h. Ensuring area agency availability 24/7 in order to provide critical incident coordination, logistical support, and subject matter expertise;

i. Completing expedited intake and eligibility supports to individuals who are experiencing a critical incident but have not sought eligibility for services through the developmental services system; and

j. Facilitating strategy development and coordination meetings in collaboration with the bureau;

(16) Monitoring, maintaining, safeguarding, and promoting human rights by:

a. Maintaining and facilitating a human rights committee, whose duties pursuant to RSA 171-A:17 for all individuals working with the committee, shall be;

1. Monitoring and approving all positive behavior change programs created pursuant to He-M 310.11;

2. Ensuring emergency physical restraint shall only be approved for safely responding to situations in which the individual presents with an imminent credible risk of significant harm to self or others by staff who are trained and certified in recognized intervention modalities;

3. Evaluating the treatment and habilitation provided to individuals;

4. Regularly monitoring the implementation of individual service agreements;

5. Monitoring the use of restrictive or intrusive interventions designed to address challenging behavior pursuant to He-M 310.11; and

6. Promoting advocacy programs on behalf of individuals;

b. Offering and providing to those who register, 2 trainings per year on advocacy and individual rights;

c. Maintaining and distributing a list of current advocacy groups within the catchment area; and

d. Completing informal investigations pursuant to He-M 202.05;

(17) Managing catchment region risk by:

a. Coordinating and facilitating a local risk management committee whose duties shall be:

1. Reviewing and analyzing referrals from service coordinators related to violent aggression, problematic sexual behavior, or fire-setting behaviors;

2. Making assessment or evaluation referral recommendations to service coordinators for individuals exhibiting behaviors including but not limited to violent aggression, problematic sexual behaviors, or fire-setting behaviors;

3. Reviewing assessment and evaluation results completed for individuals for whom a referral was submitted in accordance with 2. above to determine whether a need is identified for a plan to manage risk;

4. Providing consultation to service coordinators in identifying providers to create plans to manage risk who have expertise in the areas identified in 1. above;

5. Reviewing plans to manage risk created when a recommendation for such a plan was made pursuant to 4 above to ensure it appropriately applies assessment or evaluation recommendations received pursuant to 3. above;

6. Participating in committees and other groups related to risk management including, but not limited to, statewide risk management committees, and communities of practice to determine application of assessment or evaluation recommendations received pursuant to 2. above;

7. Reviewing documentation from service coordinators and provider agencies on an ongoing basis to determine the impact of such data relative to management of risk for an individual and related plans;

8. Ensuring that plans to manage risk created when a recommendation for such a plan was made pursuant to 4 above are reviewed regularly with individuals and their treatment team to consider ongoing appropriateness and, in the event that potential changes are indicated, seeking additional consultation with providers qualified to conduct and author assessments, whether they created the initial plans or are new, to discuss opportunities for modification of restrictions by sharing data regarding the individual's progress in treatment. Such considerations shall be made through reassessment or through a consultative review of other documentation and updated data related to the individual's progress;

9. Offering recommendations to the area agency for training for the service system;

10. Offering recommendations, as applicable, to service coordinators for individual-specific training needs;

11. Conducting training related to risk management activities, as requested by the area agency;

12. Ensuring that provider agencies and providers are trained in risk management plans;

13. Ensuring that relevant area agency personnel, provider agencies, and providers receive recommendations for clinically specialized trainings, based on assessed needs of the individuals supported, that enable these personnel to successfully complete risk management activities; and

14. Ensuring monthly representation in the statewide risk management committees; and

b. Collaborate with all area agencies to co-facilitate and convene a statewide risk management committee;

(18) Managing Health Risk Screening Tool (HRST) IntellectAbility accounts and data at by:

a. Providing administrative support for HRST account management; and

b. Completing a clinical review for individuals with a score greater than or equal to 3;

(19) Managing New Hampshire Easy (NH Easy) accounts and data by:

a. Ensuring that appropriate staff receive and maintain access to NH Easy in order to carry out duties;

b. Ensuring that the area agency's NH Easy account remains in good standing; and

c. Notifying NH Easy support of any noted system issues;

(20) Completing the request for the funding of a public guardian if the individual does not have a service coordinator;

(21) Participating in medication administration planning by:

a. Attending the state medication committee meeting as defined in He-M 1201.11;

b. Reviewing the 6-month medication error reports described in He-M 1201.11(c)-(e); and

c. Offering and providing to those who register, training to provider agencies and providers about medication administration trends as determined by the state medication committee and confirmed by the bureau;

(22) Completing information gathering via survey by:

a. Disseminating and coordinating the annual national core indicator satisfaction surveys;

b. Reviewing survey results to identify areas of quality improvement; and

c. In partnership with the bureau, distributing and reviewing survey results to ensure continuous quality improvement of the service delivery system;

(23) Maintaining records pursuant to He-M 503, He-M 510, He-M 517, He-M 519, and He-M 522, as applicable; and

(24) Managing transitions between regions.

(b) Failure of a provider agency to comply with the requirements in He-M 504 with respect to providing an area agency with necessary information or participating in activities in order for an area agency to carry out its responsibilities in (a) above shall not be considered noncompliance by an area agency.

(c) In instances of a provider agency failure as reflected in (b) above, the area agency shall notify the bureau within 15 days.

(d) For items (a)(4)-(24), Medicaid administrative reimbursement may be claimed by the designated and contracted area agency for activities completed each month on behalf of individuals in the area who are eligible for or seeking eligibility for Medicaid.

(e) Pursuant to RSA 171-A:18, I, the area agency shall be the primary recipient of these funds provided by the bureau for use in establishing, operating, and administering supports and services and coordinating these with existing generic services on behalf of individuals in the area. The area agency may receive funds from sources other than the bureau to assist it in carrying out its responsibilities.

(f) In order to collect Medicaid administrative reimbursement, pursuant to (d) above, the area agency shall:

(1) Ensure that records are maintained to support that the services in (a)(4)-(24) above were provided in the manner that was claimed;

(2) Ensure that records pursuant to (1) above are made available to the bureau or any state or federal auditing entity; and

(3) Provide information regarding services, supports, and costs, as requested by the department not less than every 5 years.

(g) When possible, the area agency shall utilize community based, integrated services, rather than establish separate services for people with developmental disabilities or acquired brain disorders.

N.H. Admin. Code § He-M 505.03

#1647, eff 10-14-80; ss by #2020, eff 5-11-82; ss by #2678, eff 4-18-84; ss by #4667, eff 8-25-89; ss by #4729, eff 1-15-90, EXPIRED: 1-15-96

New. #6871, eff 10-21-98; amd by #8443, eff 1-1-06; amd by #8728, INTERIM, eff 10-21-06, EXPIRED: 4-19-07

New. #8928, eff 6-30-07

Amended by Volume XXXV Number 36, Filed September 10, 2015, Proposed by #10916, Effective 8/26/2015, Expires8/26/2025.

Amended by Number 2, Filed January 11, 2024, Proposed by #13842, Effective 12/29/2023, Expires 12/29/2033.