N.H. Admin. Code § He-W 536.03

Current through Register No. 36, September 5, 2024

Section He-W 536.03 - Provider Participation

All participating medical services clinics shall meet the following criteria in either (a) or (b) below:

(a) Medical services clinics that are not mobile immunization providers shall meet the following criteria:

(1) Be composed of New Hampshire licensed practitioners who meet the provider requirements for the particular medical service being performed as set forth in He-W 511 through He-W 577;

(2) Provide recipient care that is under the supervision of a licensed physician affiliated with the clinic which shall mean that:

a. The physician is readily available to provide direction either by phone or in person;

b. The physician has seen the recipient as a patient at least once and assesses the need for continuing care as necessary; and

c. The physician assumes professional responsibility for the services provided to the recipient;

(3) Provide medical care on an outpatient basis;

(4) Be organized and operated independently from a hospital pursuant to 42 CFR 440.90;

(5) Be an enrolled New Hampshire medicaid provider; and

(6) Request and obtain prior authorization from the department before providing services which require prior authorization as specified in He-W 511 through He-W 577; or

(b) Medical services clinics that are mobile immunization providers shall meet the following criteria:

(1) Be composed of, and provide immunizations by, New Hampshire licensed practitioners whose licensure allows them to provide immunizations;

(2) Be under contract with, or have a current vaccine provider agreement with, the department's division of public health services;

(3) Provide immunizations to recipients in settings such as walk-in clinics, retail stores and outlets, pharmacies, and schools;

(4) Provide immunizations as medicaid services only in those settings and for those types or ages of recipients addressed in the contract or agreement in (2) above;

(5) Provide services "under the direction of a physician", which means through standing orders or other indirect supervision where the physician is not necessarily on site but who assumes professional responsibility for the services provided to the recipient;

(6) Affiliate with the directing physician through a contractual agreement or any other formal arrangement which obligates the physician to supervise the care provided to the recipient by the clinic;

(7) Be organized and operated independently from a hospital pursuant to 42 CFR 440.90; and

(8) Be an enrolled New Hampshire medicaid provider.

N.H. Admin. Code § He-W 536.03

(See Revision Note at chapter heading He-W 500); ss by #6133, eff 11-30-95; ss by #7825, eff 2-8-03; ss by #9860, eff 2-8-11

Amended by Volume XXXIX Number 10, Filed March 7, 2019, Proposed by #12732, Effective 2/22/2019, Expires 8/21/2019.

Amended by Volume XXXIX Number 41, Filed October 10, 2019, Proposed by #12877, Effective 9/25/2019, Expires 9/25/2029.