Section He-W 508.06 - Monitoring and Determination of Cost Effectiveness(a) In accordance with RSA 167:3-e, IV, the medical services proposed for a recipient shall be cost effective if the estimated cost of care outside an institution is no higher than the estimated medicaid cost of appropriate institutional care.(b) For each recipient, cost effectiveness shall be monitored monthly and determined annually by the department as follows: (1) The department shall obtain Title XIX payment data on the costs paid by Title XIX for the recipient's home care from the department's cost reports generated for each recipient from the Medicaid Management Information System (MMIS) ;(2) For each recipient, the items or services included in the home care cost data in (1) above shall include only those items or services listed in (c) below;(3) The items or services included in (d) below shall not be included in home care cost data for (1) above, or in institutional cost of care data in (c) below;(4) The department shall utilize, as institutional cost of care data, the most recently published inpatient per diem Title XIX rates for hospitals, psychiatric hospitals, nursing facilities, or ICF-MR;(5) The department shall determine the per diem rate to use as the recipient's institutional cost of care by selecting the rate for the facility in (4) above that most closely corresponds to the degree of care determined and utilized for the recipient's eligibility determination pursuant to He-W 508.04; and(6) The department shall compare the costs of the recipient's home care to the recipient's institutional cost of care, as determined in He-W 508.06(b) (1) -(b) (5) .(c) The costs associated with the following categories of service, which are included in an institution's per diem rate, shall be the only costs utilized in determining the costs incurred for the recipient's home care in accordance with He-W 508.06(b) (1) and (2) above: (1) Mental health services, including psychotherapy and community mental health center services;(2) Family planning services;(3) Drugs which are included in the per diem of the institution in (b) (4) above that is utilized in the calculation in (b) (6) above;(4) Durable medical equipment;(7) Private duty nursing services;(9) Occupational therapy;(11) Care provided through the Home and Community Based Care for the Developmentally Disabled waiver in accordance with He-M 517, with the exception of assistive technology support services, environmental modifications, employment services, respite and specialty services that would not otherwise be included in the institutional per diem rate;(12) Home and community-based care provided through the In Home Supports Waiver for Children with Developmental Disabilities in accordance with He-M 524, with the exception of environmental modifications, respite, and consultative services not otherwise included in the institutional per diem rate;(13) Case management services;(15) Early supports and services.(d) Costs associated with the following categories of service, which are not included in an institution's per diem rate, shall not be included in home care cost data in (b) (1) above or in institutional cost of care data in (c) above: (1) Inpatient services, including acute psychiatric admissions;(5) Medical assistance services provided by education agencies in accordance with He-M 1301;(7) Wheelchair van services;(9) Ophthalmology services;(11) Chiropractic services;(12) Physician services, including services of a psychiatrist;(13) Advanced registered nurse practitioner services;(14) DCYF/DJSS medicaid funded services to include private non-medical institutional placement services (PNMI) and residential placement;(15) Youth development center or other youth detention center placements;(16) Rural health clinics and federally qualified health centers;(17) Short term stays of 30 days or less in an intermediate care facility for the mentally retarded or in a nursing facility;(18) Services provided on an acute or short-term basis, in response to an illness or injury, rather than care for the chronic condition which is the basis for the home care;(19) Mileage reimbursement; and(20) Medicaid health insurance premium payments.N.H. Admin. Code § He-W 508.06