N.H. Admin. Code § He-W 552.03

Current through Register No. 2, January 9, 2025

Section He-W 552.03 - Recipient Eligibility

(a) Medicaid recipients shall be eligible for PCA services when the recipient:

(1) Is at least 18 years of age;

(2) Is their own legal guardian;

(3) Is chronically wheelchair-mobile;

(4) Is approved to participate in an independent living program by a provider of PCA services;

(5) Is able to participate in activities of daily living (ADLs), which are the basic self-care tasks of everyday life, such as eating, bathing, dressing, toileting, and transferring;

(6) Is able to self-direct, which means the recipient is capable of:

a. Making informed choices about their PCA services; and

b. Selecting, directing, supervising, and managing the PCA in the implementation of a plan of care;

(7) Is living in a non-institutional environment, but requires a minimum of 2 hours of medically oriented PCA services per day; and

(8) Has a demonstrated need for PCA services as required by (c) below.

(b) The requirements in (a)(6) above shall not preclude the recipient from obtaining assistance with the task of selecting and directing the PCA.

(c) A demonstrated need for PCA services shall be documented by:

(1) Documentation from the recipient's physician that includes:

a. A statement certifying that, based on the physician's assessment of the recipient's abilities and of the frequency and scope of the medical interventions needed by the recipient, PCA services are medically necessary as defined in He-W 530.01;

b. A description of the specific PCA services and tasks that the recipient needs assistance with; and

c. The number of hours of PCA services needed on a daily or weekly basis; and

(2) Documentation signed by the recipient indicating that the recipient's needs cannot be fully met with natural supports, including:

a. A statement attesting that the PCA services are intended to assist the recipient, not to replace or supplant the help already available to the recipient from family members, community resources, or other natural supports; and

b. Information detailing why the legally responsible adult is not able to provide the care that is needed, such as physical limitations or a work schedule that limits their availability.

N.H. Admin. Code § He-W 552.03

(See Revision Note at chapter heading He-W 500); ss by #4993, eff 11-30-90, EXPIRED: 11-30-96

New. #6742, eff 4-30-98; ss by #8597, eff 3-30-06; ss by #10562, INTERIM, eff 3-30-14, EXPIRES: 9-26-14; ss by #10676, eff 9-26-14 (from He-W 552.02)

Amended byVolume XXXIV Number 41, Filed October 9, 2014, Proposed by #10676, Effective 9/26/2014, Expires 9/26/2024.

Amended by Number 2, Filed January 9, 2025, Proposed by #14154, Effective 12/21/2024, Expires 12/21/2034.