N.H. Admin. Code § He-P 301.17

Current through Register No. 45, November 7, 2024

Section He-P 301.17 - Tuberculosis Patient Care Financial Assistance Program

(a) Tuberculosis (TB) patient care financial assistance shall be provided for tuberculosis related treatment and services 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 the following patient care:

(1) Medications approved by the Federal Food and Drug Administration for the treatment of tuberculosis, latent tuberculosis infection, or any medical condition caused by tuberculosis or tuberculosis medications;

(2) Licensed healthcare provider visits for active tuberculosis and high risk latent tuberculosis diagnosis, treatment and follow-up, when indicated;

(3) Diagnostic procedures to diagnose or monitor the disease;

(4) Laboratory tests related to the diagnosis of tuberculosis or its treatment; and

(5) Home health agency visits to provide directly observed therapy.

(c) Financial assistance for approved TB patient care shall be provided for applicants who meet the following eligibility requirements:

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

(2) Are infected with active tuberculosis or high-risk Latent Tuberculosis Infection, or those undergoing diagnostic procedures because of suspected TB;

(3) Are under a physician's care for TB; and

(4) Have an annual gross household income which is less than 300% of the Federal poverty income guidelines.

(d) As the payor of last resort, 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 shall notify the program in writing within 30 days of any change in the recipient's medical insurance coverage which results in coverage for patient care costs which are being paid for by the program.

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

(1) The name and address of the applicant;

(2) Documentation of active tuberculosis or high-risk latent tuberculosis infection diagnosis, or a statement that the applicant is undergoing diagnostic procedures because of suspected TB;

(3) Proof of New Hampshire residency;

(4) A statement of financial resources signed by the applicant, including any of the following:

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

b. A recent pay stub for each individual in (g) (4) a. above;

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

d. In the case of zero income, a letter from the healthcare provider or public health nurse case manager attesting to means of financial support.

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

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

(1) The name and address of the applicant; and additional information about the applicant including:

a. Place of birth, social security number, race, sexual orientation, and ethnicity;

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;

(2) Proof of NH residency;

(3) Documentation of active tuberculosis or high-risk latent tuberculosis infection;

(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

e. Copy of insurance card or proof of insurance, if applicable;

(i) A signed authorization that:

(1) The applicant understands that DHHS:

a. 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;

b. Shall follow all federal and state laws and rules prohibiting such discrimination; and

c. Shall provide the applicant with access to information about filing a report of any perceived such discrimination;

(2) That financial statements made as part of the application and eligibility determination are true and correct to the best of the applicant's knowledge,

(3) The applicant understands that:

a. Intentional misrepresentations may result in legal action on the basis of state or federal laws; and

b. That participation and eligibility shall be denied if information is intentionally withheld, misrepresented or omitted;

(5) The applicant shall notify NH TB Financial Assistance Program within 30 days of any change in name, address, eligibility, financial, insurance status or household size, income or medical expenses and to provide evidence thereof;

(6) The applicant authorizes his or physician, or physician's representative to release information relative to the content of the applicant's medical record to NH TB Financial Assistance Program and the department for the purpose of determining eligibility as described in He-P 301.17(c);

(7) The information from the medical record including the applicant's identity shall be maintained in strict confidence and not revealed to any person outside of the department;

(8) The applicant authorizes the staff at NH TB Financial Assistance Program to communicate with and release information including the applicant's diagnosis to physicians and other health care professionals including the applicant's pharmacist, case manager and other treatment providers to ensure planning and delivery of services to the applicant; and

(9) The releases in (6) and (8) above are valid for one year from the date of signature unless revoked by the applicant in writing.

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

(k) 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 301.17(c), the applicant shall remain eligible for 12 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 before the eligibility commencement;

(3) The commissioner shall evaluate eligibility for financial assistance prior to the expiration of the 12 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 can reapply when and if the financial or medical status changes.

(l) Notice of determination and notice of other action shall be as follows:

(1) The commissioner shall notify the applicant within 10 days from the date of receipt of application that the commissioner has determined that the applicant is eligible or ineligible for assistance; and

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

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

(1) If an applicant is dissatisfied with any 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 in writing after the case review conference whether he or she concurs, modifies or revokes the determination; and

(3) If the applicant is dissatisfied with the result of the case review conference, he or she 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.

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

(p) 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.

(o) The applicant shall contact the ID Care Services manager if eligibility is denied, and may contact the NH section director if dissatisfied with the response from the ID Care Services manager.

(p) Reimbursement shall be made directly to the provider of the service or to the pharmacy and not directly to the applicant.

N.H. Admin. Code § He-P 301.17

#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.