Section He-W 543.05 - Covered Services(a) Covered services shall include those services described in the various service component rules found in this chapter which may be provided in a hospital setting as either an inpatient or outpatient hospital service.(b) Inpatient hospital services shall be covered when those services are rendered: (1) By or under the direction of a physician or dentist;(2) To a recipient who has been admitted to a hospital as an inpatient;(3) For a continuous period of 24 hours or longer;(4) By a hospital offering room, board, and professional services; and(5) By a NH medicaid participating hospital which meets the requirements set forth in He-W 543.03.(c) Outpatient hospital services shall be covered when those services are rendered: (1) As preventive, diagnostic, therapeutic, rehabilitative, emergency, or palliative outpatient services;(2) Within the service limits set forth in He-W 530;(3) By or under the direction of a physician or dentist;(4) To a recipient who has not been admitted as an inpatient;(5) For a period of time less than 24 hours; and(6) By a NH medicaid participating hospital which meets the requirements set forth in He-W 543.03.(d) Observation services, as defined in He-W 543.01(m) , shall be covered in accordance with He-W 543.05(c) , above.(e) Inpatient hospital services provided at an out-of-state hospital shall be covered pursuant to the prior authorization requirements of He-W 543.04.(f) Organ transplant procedures and procurements shall be covered when performed as an inpatient service at an organ transplant facility approved by CMS and in accordance with the requirements and limits at He-W 531.N.H. Admin. Code § He-W 543.05
(See Revision Note at chapter heading He-W 500); ss by #5897, eff 9-19-94, EXPIRED 9-19-00
New. #7399, eff 11-2-00, EXPIRED: 11-2-08
New. #9324, eff 11-21-08 (from He-W 543.04 )
Amended by Volume XXXVII Number 10, Filed March 9, 2017, Proposed by #12103, Effective 2/9/2017, Expires 2/9/2027.