N.H. Code Admin. R. Agr 3504.01 – Cost of Care Reimbursement Form for Municipalities

(a) The “Cost of Care Reimbursement Form for Municipalities” may be submitted once per review period, by an arresting officer or their designee, on behalf of a municipality, to the commissioner, in order to apply for reimbursement of the costs of care incurred from caring for animals pending the resolution of any action brought for animal cruelty under RSA 644:8 or RSA 644:8-a.
(b) The arresting officer or their designee shall provide the following on the form:
1. (1) Municipality name;
2. (2) Municipality business address;
3. (3) Municipality business telephone number;
4. (4) Name and title of arresting officer;
5. (5) Court case title and docket number;
6. (6) Municipality vendor identification number;
7. (7) Certification by the arresting officer or their designee that the application is correct in all its particulars; and
8. (8) Arresting officer or designee signature, title, and date signed.
(c) Total requested reimbursement for the dates indicated shall be determined by arresting officer or their designee by:
1. (1) Indicating the date range and total number of days covered by the application;
2. (2) Separately listing for non-livestock animals:
  1. a. The number of non-livestock animals for which care was provided on each day of the specified date range; and
  2. b. The total number of reimbursable days by adding the total number of non-livestock animals cared for on each day of the specified date range;
3. (3) Multiplying the total number of reimbursable non-livestock days by $20;
4. (4) Separately listing the number of days of boarding and care provided for livestock animals;
  1. a. The number of livestock animals for which care was provided on each day of the specified date range; and
  2. b. The total number of reimbursable days by adding the total number of livestock animals cared for on each day of the specified date range;
5. (5) Multiplying the total number of reimbursable livestock days by $40;
6. (6) Separately listing the number of days of boarding and care provided for poultry animals:
  1. a. The number of poultry animals for which care was provided on each day of the specified date range; and
  2. b. The total number of reimbursable days by adding the total number of poultry animals cared for on each day of the specified date range;
7. (7) Multiplying the total number of reimbursable poultry days by $5;
8. (8) Separately listing costs incurred by animal for emergency veterinary care, not to exceed $500 per animal, during the specified date range;
9. (9) Adding the total for emergency veterinary care, not to exceed $5000 per court case, during the specified date range;
10. (10) Adding the subtotals to calculate the requested reimbursement total; and
11. (11) Attaching to the form:
  1. a. Invoices or billing records from entities providing routine daily boarding and care of animals, including the date range, total fee, the daily fee per animal, and the numbers and types of animals cared for;
  2. b. Invoices from veterinarians who provided emergency veterinary treatment; and
  3. c. Written statements from veterinarians who provided emergency veterinary treatment indicating that the specific treatment was necessary and appropriate.
(d) The form shall include a place for the administrator to sign and date that the administrator received the invoice from the participating veterinarian.
(e) An applicant shall be notified of an incomplete application at the time of receipt by the commissioner in accordance with RSA 541-A:29.
(f) Upon review by the commissioner, if an applicant meets the requirements of Agr 3502.01, then the commissioner shall:
1. (1) Sign and date Part 2 – Certification by Commissioner section of the form certifying approval was granted; and
2. (2) Submit the form to the state treasurer for payment.
  Source. #13208, eff 6-1-2121 (see Revision Note at chapter heading for Agr 3500)
  APPENDIX
  RULE NUMBER
  STATUTE IMPLEMENTED
  Agr 3501
  RSA 437:9, V
  Agr 3502 thru Agr 3504
  RSA 437-B:1, IV