Section 151-E:3 Eligibility.
I. A person is medicaid eligible for nursing facility services if the person is:
(a) Clinically eligible for nursing facility care because the person requires 24-hour care for one or more of the following purposes, as determined by registered nurses appropriately trained to use an assessment tool and employed by the department, or a designee acting on behalf of the department:
(1) Medical monitoring and nursing care when the skills of a licensed medical professional are needed to provide safe and effective services;
(2) Restorative nursing or rehabilitative care with patient-specific goals;
(3) Medication administration by oral, topical, intravenous, intramuscular, or subcutaneous injection, or intravenous feeding for treatment of recent or unstable conditions requiring medical or nursing intervention; or
(4) Assistance with 2 or more activities of daily living involving eating, toileting, transferring, bathing, dressing, and continence; and
(b) Financially eligible as either:
(1) Categorically needy, as calculated pursuant to rules adopted by the department under RSA 541-A; or
(2) Medically needy, as calculated pursuant to rules adopted by the department under RSA 541-A.
II. A person is eligible for services under the medicaid waiver if the person has been determined eligible under RSA 151-E:3, I.
III. The department shall not use a new assessment tool to determine clinical eligibility for nursing facility care until the tool has been reviewed by the county-state finance commission and has been approved by the oversight committee on health and human services established pursuant to RSA 126-A:13.
IV. If the registered nurse is unable to determine that an applicant is eligible following the clinical assessment pursuant to subparagraph I(a), the registered nurse shall obtain and give substantial weight to clinical information provided by the applicant's physician or nurse practitioner, including, but not limited to diagnosis, prognosis, and plan of care recommendations, and consider information from other licensed practitioners, including occupational or physical therapists, if available. All clinical information obtained shall also be used in the preparation of the initial support plan.
Source. 1998, 388:1. 2003, 223:10, eff. July 1, 2003. 2005, 175:2, eff. Jan. 1, 2006; 175:21, eff. Aug. 29, 2005; 175:22, eff. July 1, 2007. 2007, 330:6, 7, eff. Jan. 1, 2008; 330:11, eff. June 30, 2007. 2008, 168:1, eff. June 6, 2008.