N.H. Admin. Code § He-W 552.06

Current through Register No. 36, September 5, 2024

Section He-W 552.06 - Non-covered Services

(a) Non-covered services shall be those services for which the NH Medicaid program shall make no payment.

(b) The following activities shall not be considered PCA services:

(1) Services that are not medically oriented, including:

a. Shopping, except for grocery shopping;

b. Managing finances;

c. Care, grooming, or feeding of pets or other animals, with the exception of service animals as defined by the Americans with Disabilities Act (ADA), Title III Subpart A 36.104, or assistance animals as defined by the Fair Housing Act Section 504; and

d. Social integration activities, such as accompanying the recipient to a restaurant, to the movies, to a ball game or to any other community or social activity;

(2) Chore services, which are tasks that exceed light housekeeping and include:

a. Cleaning of floors, shampooing carpets, cleaning walls, and cleaning furniture in areas not occupied by the recipient, such as cleaning the entire home rather than the area the recipient occupies;

b. Doing laundry, other than the recipient's personal laundry, such as doing laundry for the household as opposed to just the recipient's personal laundry;

c. Cleaning windows; and

d. Doing yard work, gardening, home repairs, or shoveling snow unless needed to ensure the recipient's and the PCA's safe access to and from the recipient's home when the recipient has no natural supports;

(3) Services provided outside the recipient's home for the convenience of the personal care attendant, such as care provided at the personal care attendant's home, or any other location where the recipient would not normally go within the community;

(4) Services performed for the convenience of the recipient, or the recipient's family member(s), or intended to otherwise replace assistance available through the recipient's natural supports system;

(5) Time spent with the recipient when no actual hands on care or other covered services are being provided, including but not limited to supervision, companion care, baby-sitting the recipient's dependents, or social visits;

(6) Services provided to a recipient while the recipient is:

a. An inpatient or resident of a hospital, nursing facility, intermediate care facility for the mentally retarded, or institution for mental disease, in accordance with 42 CFR 440.167;

b. An inmate of a public institution in accordance with 1905(a) (27) (A) of the Social Security Act; or

c. Attending a program for which personal care services are already provided, such as adult medical day care;

(7) Services provided to the recipient outside the United States;

(8) Duplicative PCA services;

(9) Any services not listed as covered under He-W 552.05;

(10) Services which are not included in the approved plan of care;

(11) Services provided to someone other than the recipient; and

(12) Care requiring the technical or professional skill that a state statute or regulation mandates must be performed by a health care professional licensed or certified by the state.

N.H. Admin. Code § He-W 552.06

(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 553.06 )

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