N.H. Admin. Code § He-P 301.11

Current through Register No. 45, November 7, 2024

Section He-P 301.11 - HIV/AIDS NH Comprehensive Aids Resource Emergency (CARE) Program

(a) HIV/AIDS financial assistance shall be provided to applicants meeting the eligibility requirements set forth in this section. Applications for financial assistance shall be considered in chronological order among all eligible applicants. However, assistance to which these rules apply shall be subject to the availability of funds and shall not be financially open-ended.

(b) Qualified applicants shall be eligible to receive financial assistance for outpatient health services, insurance services, and drugs that receive Food and Drug Administration approval for use as therapy for individuals infected with HIV and infants perinatally exposed to HIV and are authorized for payment through the program's current formulary.

(c) Financial assistance for outpatient health services, insurance services, and approved drug therapies shall be provided to applicants who meet the following eligibility requirements:

(1) Are residents of the state of New Hampshire;

(2) Are infected with HIV or infants perinatally exposed to HIV and have a physician's prescription for one or more of the drugs covered under this program;

(3) For drug services only, currently be prescribed antiretroviral drugs for the treatment of HIV/AIDS or meet one or more criteria under the US Department of Health and Human Services Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents available as noted in Appendix A; and

(4) Have an annual gross household income which is less than 500% of the Federal poverty income guidelines. The program shall maintain flexibility in implementation of the income limit, up to 10% above or below the 500% FPL threshold. The flexibility shall be utilized if changes occur in the federal funding environment or if access to health insurance and medications becomes limited.

(d) The program shall be the payer of last resort and nothing contained in these rules shall authorize or require the program to provide payment for drugs, diagnostics, or monitoring services which would otherwise be paid for by medicaid, medicare, or any other medical insurance program or policy.

(e) Each recipient of financial assistance shall notify the program in writing within 30 days of any change in the recipient's medical insurance coverage which results in coverage for drugs which are currently being paid for by the program.

(f) An application for financial assistance shall be submitted to the program before the program provides financial assistance.

(g) The application referred to in (f) above shall include:

(1) Information about the applicant including:

a. The name and address of the applicant;

b. The first three letters of the applicant's mother's first name;

c. The status of the applicant's housing and the applicant's contact information and mailing address; and

d. Information relating to contacting the applicant by answering machine, email or mail;

e. Information relating to contacting the applicant by telephone, voicemail, email, or mail;

(2) Proof of NH residency;

(3) Documentation of HIV positive status;

(4) The name and contact information for the applicant's primary and specialty care physician and pharmacy contact information;

(5) A statement of financial resources, including any of the following:

a. The current income tax form of those persons whose income is considered in determining family income;

b. Recent pay stubs for the individuals referred to in (4) a. above;

c. A letter from the employer(s) of those individuals referred to in a. above attesting to present wages; and

d. In the case of zero income, a letter from the case manager attesting to means of financial support; and

(6) A signed authorization to collect medical data and prescription coverage information through medicaid, medicare, or any medical insurance or policy necessary to determine eligibility as described in He-P 301.11(c) (2);

(7) A certification that the applicant understands that the department of health and human services shall not discriminate against people because of their age, sex race, creed, color, marital or familial status, physical or mental disability, national origin, sexual orientation or political affiliation or belief, and shall follow all federal and state laws and rules prohibiting such discrimination, and including information about filing a report of any perceived such discrimination;

(8) An acknowledgement by the applicant that he or she understands and agrees with a client certification, authorizing releases for a period of one year, and certifies the truthfulness and completeness of the financial information provided, as follows:

a. That the applicant declares all financial statements are correct and true to the best of his or her knowledge;

b. That any intentional misrepresentation shall result in potential legal action on the basis of state or federal laws;

c. That participation in NH CARE program shall be denied if the applicant withholds information, provides inaccurate or refuse to provide all necessary information;

d. That the applicant agrees to notify the NH CARE program within 30 days of any change in the applicant's name, address, eligibility, financial, or insurance status, or household size, and agrees to provide evidence of income and medical expenses, medicaid or medicare status, or health insurance policy, and agrees to send any refunds to the program which were sent to the applicant but owed to NH CARE program;

f. That in order to be considered for participation in the NH CARE program, the applicant authorizes his or her physician to release information requested by NH CARE program relative to the content of the applicant's medical record;

g. That the applicant understands that the information relative to the medical record shall be maintained under strict conditions of confidentiality and that the applicant's identity shall not be revealed to any person outside of the department (DHHS);

h. The understanding that all information given to the NH CARE program is strictly confidential and shall not be released to any other parties unless allowed by law;

i. That the applicant authorizes the staff of the NH CARE program to communicate with and release information, to administer and ensure the best possible planning and delivery of services on the applicant's behalf, and to authorize NH CARE program to speak with the applicant's employer or insurance or consolidated omnibus budget reconciliation act (COBRA) provider to ensure coverage and resolve billing issues;

j. That the applicant authorizes the department and the "City of Boston/Trustees of Health and Hospitals" to access the applicant records for monitoring purposes and shall not copy, record or remove anything from the record for a period of two years, notwithstanding the general release provided in (h) (7) above, and

k. That authorization in (h) (7) and paragraph (h) (7) j. may be revoked by the applicant at any time in writing; and (9) A certification by the applicant authorizing the applicant's physician as follows: "I hereby authorize my physician or physician's representative, to release information requested by the NH CARE program, relative to the content of my medical record. I understand that this information will be maintained under strict confidentiality, will not be revealed to persons outside the NH department of health and human services, and will be used solely for my benefit. This release is valid for one (1) year from date of signature unless revoked by me in writing."

(i) The commissioner shall determine whether the applicant meets the eligibility requirements pursuant to paragraph (c) above.

(j) The commissioner shall authorize the commencement, duration, redetermination of eligibility, and reapplication according to the following:

(1) When the commissioner determines that an applicant is eligible for financial assistance in accordance with He-P 301.11(c), the applicant shall remain eligible for 6 months commencing with the date of eligibility;

(2) The commissioner shall not reimburse the applicant or any other person for any payment that was made or debt that was incurred before the eligibility commencement or after its termination;

(3) The commissioner shall evaluate eligibility for financial assistance prior to the expiration of the 6 month period described in (1) above; and

(4) A household or individual who has applied for financial assistance and has been determined to be ineligible may reapply when and if the financial, insurance, or medical status changes.

(k) Notice of determination or other action shall be as follows:

(1) The commissioner shall notify the applicant within 10 days from the date of receipt of their application that the commissioner has determined the applicant's eligibility for assistance; and

(2) The commissioner shall notify a recipient in writing at least 30 days in advance of any action which affects the recipient's eligibility including termination of eligibility.

(l) An applicant may appeal an eligibility determination as follows:

(1) If an applicant is dissatisfied with any eligibility determination, the applicant may request, within 30 days of the date of the commissioner's notification letter, an informal case review conference;

(2) The commissioner shall notify the applicant within 14 days after the case review conference whether the commissioner concurs, modifies, or revokes the determination; and

(3) If the applicant or applicant's guardian is dissatisfied with the result of the case review conference, the applicant or guardian may request within 30 days of notification of the results of the case review conference, an adjudicative proceeding held in accordance with RSA 541-A.

(m) The applicant may contact the office of the ombudsman at any point in the process for a neutral resolution of the applicant's complaint.

(n) The applicant shall contact the NH CARE Program manager if eligibility is denied; and may contact the NH section director if dissatisfied with the response from the NH CARE program manager.

N.H. Admin. Code § He-P 301.11

#4230, eff 2-23-87; ss by #4946, eff 10-2-90; amd by #5587, eff 2-22-93; ss by #6634, eff 11-25-97; ss by #8242, eff 12-30-04; ss by #9172, eff 6-6-08; ss by #12033, eff 11-3-16; amd by #12586, eff 7-24-18

Amended by Volume XXXVI Number 45, Filed November 10, 2016, Proposed by #12033, Effective 11/3/2016, Expires 11/3/2026.

Amended by Volume XXXVIII Number 32, Filed August 9, 2018, Proposed by #12586, Effective 7/24/2018, Expires 7/24/2028.