1. (a) The LNA or MNA shall complete an application, form Bureau of Adult and Aging Services (BAAS) 292 “Application for Reimbursement for Licensed Nursing Assistant or Medication Nursing Assistant Training Program and/or Competency Testing,” (August 2024) in full attesting that the information provided in Section A of the application is accurate and that the LNA or MNA is, has been, or will be employed by the nursing facility named and shall submit the following documentation along with the application:

   1. (1) Legible and itemized receipts from the agency that provided the training or competency testing, or the entity that processed the payment that documents the proof of payment by the LNA or MNA. The receipts shall contain the applicant’s name and, if applicable, the third party payor, the description of the LNA or MNA training program or competency testing taken, and the amount(s) the applicant and third party payor, if applicable, paid for the training program or competency testing; and
   2. (2) An attached certificate from the agency that provided the training or competency testing to the LNA or MNA that shows the date the LNA or MNA successfully completed the training or competency testing.

2. (b) If a third party is seeking reimbursement for paying for an LNA or MNA’s training or competency testing, the third party shall provide the following on the application:

   1. (1) The amount requested for training program or competency testing reimbursement;
   2. (2) The third party’s dated signature attesting that the information provided in section b of the application is accurate that the third party has paid the amount listed in (b)(1) above for LNA or MNA training or competency testing for the applicant; and
   3. (3) Attach legible and itemized receipts from the agency that provided the training or competency testing, or the entity that processed the payment, that documents proof of payment by the third party. The receipt shall contain the third party’s name, the description of the LNA or MNA training program or competency testing taken, and the amount that the third party paid for the training program or competency testing.
3. (c) The LNA, MNA, or third party shall submit the application and accompanying documentation required in (a) above or (b) above, or (a) and (b) above if applicable, to the administrator of the employing nursing facility.
4. (d) The nursing facility administrator shall complete section c on the application.

5. (e) The nursing facility administrator shall submit the completed application to the department by mailing it to:

   The Department of Health and Human Services

   Bureau of Adult and Aging Services

   Attn: Nursing Assistant Reimbursement105 Pleasant Street

   Concord, NH 03301-3857.

6. (f) The bureau of adult and aging services shall review the application for completeness, accuracy, and to verify that the individual is an LNA or MNA.

Source. #7752, eff 8-17-02, EXPIRED: 8-17-10 New. #9769-B, eff 8-25-10; ss by #12717, eff 1-26-19; ss by #13242, eff 7-24-21; ss by #13735, eff 10-1-23; ss by #14057, eff 8-20-24