Section He-W 571.10 - Payment for Items(a) The department shall establish rates for all items in accordance with RSA 161:4, VI(a) .(b) All dispensing providers shall submit clean claim(s) as defined in He-W 571.01(c) .(c) All dispensing providers shall submit clean claims for payment to the department's fiscal agent, and the department shall be entitled to recoupment of state and federal medicaid payments as permitted in 42 CFR 455, 42 CFR 456, and 42 CFR 447.(d) All dispensing providers shall maintain supporting records supporting submitted claims in accordance with He-W 520 and He-W 571.07.(e) Payment shall not be made for items that require prior authorization when prior authorization was not received and approved before the items were provided, in accordance with He-W 571.05. Retroactive prior authorization requests shall be denied.(f) Payment for disposable incontinence supplies, including gloves and toileting wipes used for this condition, provided to recipients shall be made only for supplies obtained from the exclusive supplier of incontinence supplies contracted through the department.(g) Billing of and payment for items and repair parts shall be made at the lesser of: (1) The dispensing provider's usual and customary charge to the public, as defined in RSA 126-A:3, III(b);(2) The lowest amount the dispensing provider accepts from any other third party payor; or(3) The rate established by the department in accordance with RSA 161:4, VI(a) .(h) Payment for labor costs for repairs shall be at a rate established by the department in accordance with RSA 161:4, VI(a) .(i) Payment shall be denied or recouped if the dispensing provider bills for and is paid for disposable incontinence supplies, including gloves and toileting wipes used for such condition, which are not obtained from the exclusive supplier of incontinence supplies contracted through the department.(j) Except as allowed by (k) below, payment shall be denied if the recipient is not eligible on the date of service, even when a prior authorization request has been approved.(k) For the following items only, payment shall be denied if the recipient is not medicaid eligible on the date of service as defined in He-W 571.01(a) .(l) No item shall be paid for prior to delivery to the recipient and dispensing providers shall maintain documentation in accordance with He-W 571.07 and 571.10 which demonstrates that the items were delivered to the recipient.(m) No payment shall be made for items left unattended which results in the item(s) destruction or damage to the item so that it is unusable.(n) In accordance with the payment rates established in (a) above, the rate for wheelchairs shall include the following required services: (1) Delivery and assembly of the wheelchair;(2) Training to the recipient and recipient's family and other caregiver(s) in the use of the equipment, maintenance care, and equipment diagnostics; and(3) Wheelchair adjustments and any follow-up training within 30 days following the delivery of the chair.(o) Dispensing providers shall supply a comparable substitute wheelchair at no additional cost for 2 weeks during the repair of the original wheelchair. For repairs that require more than 2 weeks to complete, the dispensing provider may request PA for a rental fee.N.H. Admin. Code § He-W 571.10
(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
Amended by Volume XXXVI Number 10, Filed March 10, 2016, Proposed by #11046, Effective 2/27/2016, Expires 2/27/2026.