Section 167:3-f Home Care for Children With Severe Disabilities; Recipient Eligibility.
I. In this section:
(a) ""Active treatment program'' means an aggressive, consistent implementation of specialized and generic training, treatment, health, and related services directed toward:
(1) The acquisition of the behaviors necessary for the child to function with as much self-determination and independence as possible; and
(2) The prevention or slowing of deterioration of the ability to function.
(b) ""Family centered community-based home care'' means an organized network of integrated and coordinated services delivered at the local level which promotes normal patterns of living and which recognizes the pivotal role of families with respect to the provision of services for their children.
(c) ""Cost effective'' means the estimated medicaid cost of care outside an institution is no higher than the estimated medicaid cost of appropriate institutional care.
II. The purpose of family centered community-based home care shall be to support but not supplant the child's family as the primary caregiver.
III. To be eligible for medical assistance for home care of certain children with severe disabilities, the child shall, in addition to the eligibility criteria in RSA 167:3-e:
(a) Reside in a place maintained as the child's home community.
(b) Be able to receive services in the home as defined in 45 CFR 233.90(c)(1)(v)(B).
(c) Meet the program criteria as described in section 1902(e)(3) of the Social Security Act.
(d) Meet the recipient criteria of He-W 641.04, except that, pursuant to the prohibition in section 1614(f)(2)(B) of the Social Security Act, rules requiring the deeming of parental income shall not apply.
(e) Meet the following medical criteria:
(1) Is chronically ill or impaired, whose illness or disability does not require the level of care provided in an inpatient facility, but whose condition requires ongoing and regular medical monitoring and treatment; and
(2) Has a severe disability which includes at least one of the following:
(A) A developmental disability as defined in RSA 171-A:2, V.
(B) A chronic, degenerative, progressive, or life-threatening condition causing impairment of a vital organ function which requires ongoing and regular medical monitoring.
(C) A sensory impairment which is expected to continue indefinitely, including a hearing loss established by audiometry which functionally impacts the child.
(D) A mental illness, emotional disturbance or behavioral disorder which functionally impacts his or her psychosocial adjustment and the diagnosis for which is recognized by the American Psychiatric Association.
(E) An acquired childhood disease which functionally impacts the child.
(F) A genetic disorder or congenital anomaly requiring ongoing medical monitoring.
(f) Require the same degree of care that is typically provided in a hospital, psychiatric hospital, nursing facility, or intermediate care facility as specified in RSA 167:3-g.
IV. In addition to the eligibility requirements described in paragraph II, the services proposed for the child shall be:
(a) Medically appropriate, as determined by the joint medical review team in accordance with paragraphs V and VI; and
(b) Cost effective as determined by the department in accordance with RSA 167:3-e, IV.
V. The joint medical review team, upon certification by the child's physician, shall determine if it is medically appropriate, in accordance with paragraph VI, for the child to receive family centered community-based home care as opposed to institutional care.
VI. The joint medical review team shall determine that family centered community-based home care is medically appropriate if each of the following conditions are met:
(a) The care can be provided in the home without jeopardizing the medical needs of the child.
(b) Medical and psychological support services are available in the community.
(c) The child's treating physician recommends home care and certifies the safety of home placement.
(d) The child's family or guardian has expressed a willingness and desire to assume responsibility as the primary caregiver for the child in order to maintain the child at home.
(e) The family and household members have been trained to support the child's needs in the home and have the ability to be primary caregivers.
Source. 2005, 181:2, eff. Aug. 29, 2005. 2008, 52:5, eff. July 11, 2008.