Section He-W 571.01 - Definitions(a) "Apnea of prematurity" means that one of the following has occurred to an infant: (1) The sudden cessation of breathing that lasts for at least 20 seconds;(2) The sudden cessation of breathing for any length of time, which is accompanied by bradycardia, which means a heart rate less than 80 beats per minute;(3) O2 desaturation, which means O2 saturation of less than 90% with cyanosis or pallor in an infant younger than 37 weeks gestation; or(4) The presence of marked hypotonia.(b) "Apparent life-threatening event (ALTE) " means one or more of the following conditions affecting an infant: (2) Change in skin color;(3) Marked change in muscle tone, usually marked limpness; or(c) "Clean claim(s) " means a claim that can be processed without obtaining additional information from the dispensing provider or from a third party, including a claim with errors originating in the state's claims system, and not including a claim from a dispensing provider who is under investigation for fraud or abuse or a claim under review for medical necessity.(d) "Date of service" means the date that the item is delivered to or received by the recipient except: (1) For custom wheelchairs, the date the custom wheelchair is ordered;(2) For custom fabricated prosthetic and orthotic devices, the date of fabrication;(3) For frame and seating systems to pediatric and adult wheelchairs, the date of the order; or(4) For medical supplies that are dropped shipped, the date of shipment.(e) "Department" means the New Hampshire department of health and human services.(f) "Dispensing provider" means the company or the company's authorized representative providing the item to the recipient.(g) "Durable medical equipment (DME) " means a type of item that is: (1) Non-disposable and able to withstand repeated use;(2) Primarily used to serve a medical purpose for the treatment of an acute or chronic medically diagnosed health condition, illness, or injury; and(3) Not useful to an individual in the absence of an acute or chronic medically diagnosed health condition, illness, or injury.(h) "Item(s) " means any DME, prosthetic devices, mobility devices, orthotic devices, or medical supplies.(i) "Letter of medical necessity (LMN) " means a letter, signed by the ordering physician, physician assistant, or advanced practice registered nurse (APRN) certifying the need for the item being requested.(j) "Life sustaining" means medical interventions that utilize mechanical or other artificial means to sustain, restore, or supplant a vital function, which serve only or primarily to prolong the moment of death, and where, in the judgment of the attending and consulting physicians, as reflected in the recipient's medical records, death is imminent if such interventions are not utilized.(k) "Medicaid" means the Title XIX and Title XXI programs administered by the department, which makes medical assistance available to eligible individuals.(l) "Medical supplies" means a type of consumable or disposable item appropriate for relief or treatment of a specific medically diagnosed health condition, illness, or injury.(m) "Mobility devices" means a type of item specifically designed for use by individuals with a mobility-related injury, illness, or disability that helps the individual walk or move from place to place, and includes manual and power wheelchairs, strollers, scooters, walkers, gait trainers, crutches, canes, or similar devices.(n) "Monthly quantity" means the amount of medical supplies allowed per month.(o) "Orthotic devices" means a type of orthopedic item that is applied externally to the limb or body to: (1) Protect against injury;(2) Support a weak or deformed portion of the body; or(3) Prevent or correct a physical deformity or malfunction.(p) "Prosthetic devices" means a non-dental, artificial type of replacement, corrective or supportive device or part of a device used to: (1) Replace a missing portion of the body; or(2) Replace a missing function of the body.(q) "Provider" means a New Hampshire licensed ordering physician, APRN, physician assistant, or an ordering occupational or physical therapist specializing in rehabilitation medicine.(r) "Recipient" means any individual who is eligible for and receiving medical assistance under the medicaid program.(s) "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.(t) "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.N.H. Admin. Code § He-W 571.01
(See Revision Note at chapter heading He-W 500); ss by #6158, eff 12-29-95, EXPIRED: 12-29-03
New. #8961, eff 8-20-07; amd by, INTERIM, #8983, eff 9-21-07, EXPIRES: 3-19-08 (deletion of former paras. (d) & (h) and renumbering remaining paragraphs); amd by #10139, eff 7-1-12
Amended by Volume XXXVI Number 10, Filed March 10, 2016, Proposed by #11046, Effective 2/27/2016, Expires 2/27/2026.