Section He-W 520.01 - Definitions(a) "Department" means the New Hampshire department of health and human services.(b) "Direct ownership interest" means the possession of equity of 5% or greater in capital, stock, or profits of the provider or provider applicant.(c) "Early and periodic screening, diagnosis, and treatment (EPSDT) " means a program pursuant to 42 CFR 440.40, designed to provide medical care to recipients under the age of 21.(d) "High risk provider or high risk provider applicant" means an individual or entity which meets one of the criteria in He-W 520.06(c) .(e) "Indirect ownership interest" means an ownership interest of 5% or greater in an entity that has a direct ownership interest in the provider or provider applicant.(f) "Medicaid" means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.(g) "Medicaid management information system (MMIS) " means the general system for mechanized claims processing and information retrieval recommended by the Centers for Medicare and Medicaid Services (CMS) for the implementation of the requirements of state fiscal administration pursuant to 42 CFR 433, Subpart C.(h) "Presumptive eligibility" means an eligibility period as described in Section 1920A of the Social Security Act during which eligibility for a child is determined for the medicaid program.(i) "Provider" means an entity or individual who furnishes health care services or supplies to medicaid recipients under an agreement with the department.(j) "Provider applicant" means an individual or entity who is undergoing the provider enrollment or re-enrollment process to become a New Hampshire medicaid provider.(k) "Qualified entity" means an entity authorized and trained by the department to determine presumptive eligibility pursuant to the provisions of Section 1920A(b) (3) (A) of the Social Security Act, including providers that are: (1) Title V-funded family and community health agencies;(2) Title X family planning agencies;(4) Agencies authorized to determine eligibility for the Head Start program;(5) Agencies authorized to determine eligibility for child care services provided under the Child Care and Development Block Grant Act;(6) Agencies participating in the Early Intervention Program; and(7) Agencies participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) .(l) "Recipient" means any individual who is eligible for and receiving medical assistance under the medicaid program.(m) "Revalidation" means the process through which the provider verifies the accuracy of, and updates if necessary, its current provider enrollment information.(n) "Termination" means that the department revoked a provider's medicaid billing privileges.(o) "Title XIX" means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.(p) "Title XXI" means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.(q) "Utilization review and control" means the monitoring of medicaid program services pursuant to 42 CFR 455 and 42 CFR 456.N.H. Admin. Code § He-W 520.01
(See Revision Note at chapter heading He-W 500); ss by #6574, eff 9-12-97; ss by #6745, eff 5-1-98, EXPIRED: 12-31-98; ss by #6925, eff 1-1-99; amd by #7666, eff 4-1-02; ss by #8781, eff 1-1-07; amd by #10139, eff 7-1-12
Amended byVolume XXXV Number 06, Filed February 12, 2015, Proposed by #10776, Effective 1/31/2015, Expires7/30/2015.Amended by Volume XXXV Number 32, Filed August 13, 2015, Proposed by #10887, Effective 7/17/2015, Expires7/17/2025.Amended by Volume XXXVII Number 19, Filed May 11, 2017, Proposed by #12166, Effective 4/29/2017, Expires 4/29/2027.