1. (a) Subject to (1) through (4) below, a program’s eligibility for reimbursement shall begin on the child’s day of admission and continue through the day of discharge, as follows:

   1. (1) The department shall only reimburse a certified residential treatment program for a child’s treatment when there is no concurrent payment for placement being made to another residential treatment program, with the exception of the day of admission or the day of discharge, or both;
   2. (2) A certified residential treatment program shall be reimbursed for the day of admission when a child is admitted to the residential treatment program directly from an assessment residential treatment program. If the child is admitted to a residential treatment program of the same agency that provided the assessment residential treatment program, the residential treatment program shall not be reimbursed for the day of discharge from the assessment residential treatment program;
   3. (3) The department shall reimburse a New Hampshire PRTF provider in accordance with 4.19-C of the medicaid state plan; and
   4. (4) The department shall reimburse a New Hampshire private non-medical institution (PNMI) provider in accordance with 4.19-C of the medicaid state plan.
2. (b) If a child has an identified MCO that will be funding the residential treatment program, the program shall only admit the child if the program is enrolled with that child’s MCO.
3. (c) The residential treatment program may subcontract with other human services providers to fulfill a service which is intended to be provided by the program. The program shall be reimbursed at the daily per-diem rate and the subcontractor shall be reimbursed by the program.
4. (d) Any subcontractor used on a temporary or long-term basis shall operate with a current license or operate under the laws that govern that profession, if applicable. If the program is in another state, the subcontractor shall operate in accordance with the laws of the state in which it operates, as applicable.
5. (e) The department shall have no obligation to reimburse a subcontractor for services performed or provided in accordance with (c) above.
6. (f) Residential treatment programs shall not request additional reimbursement for residential treatment services identified within this part. If a need for a child is identified in excess of the program budget and residential level of care, prior authorization shall be sought by the residential treatment program to the department for consideration.
7. (g) In the event that a child is a runaway, is committed or detained pursuant to RSA 169-B, or is admitted to an in-patient psychiatric or acute care hospital, the residential treatment program may bill through the day that the child runs away, is committed or detained, or is admitted to the in-patient psychiatric or acute care hospital.

8. (h) The program may seek prior approval from an administrator at the department to hold a bed under He-C 6350.35. When approved, the program may choose to hold the bed for up to 7 days. A bed hold shall be approved by the department when:

   1. (1) The program is committed to the youth returning to the program; and
   2. (2) The program is most clinically appropriate to support the child, and family, at this time: and
   3. (3) The program is the most appropriate setting for the child to return to.

9. (i) If a bed hold is approved by the department the program shall:

   1. (1) Maintain communication with the treatment team, the child, and the family; and
   2. (2) Not bill medicaid for the time when the child is a runaway, absconder, missing, or admitted to a hospital.
10. (j) If agreed upon by the residential treatment program and the department, the program from which the child ran away or absconded may readmit the child within 10 business days from the date the child ran away or absconded in compliance with He-C 6350.35. Readmission within 10 business days shall not negate the billing requirement identified in (a) or (g) above.
11. (k) PNMI and PRTF programs shall provide documentation regarding their budgets and rates to the department in accordance with the medicaid state plan.
12. (l) Out-of-state programs shall submit updated rates established by their state entity or rate request 30 days from the effective date or when requested by the department within 30 days.

Source. #4442, eff 7-1-88, EXPIRED 7-1-94 New. #6617, eff 10-25-97; ss by #8453, INTERIM, eff 10-25-05, EXPIRED: 4-23-06 New. #8693, eff 7-27-06; ss by #10759, eff 1-17-15 ss by #14178, INTERIM, eff 1-18-25; ss by #14490, eff 1-22-26, EXPIRES: 1-22-36