1. (a) Each NF of atypical care shall be an NF or a distinct part of an NF which possesses the physical characteristics and appropriate staffing for, and devotes its services exclusively to, highly specialized care, the nature of which renders that NF or unit incomparable to other NFs for the purpose of calculating and applying cost and occupancy limits.

2. (b) Examples of such care described in (a) above shall include services for:

   1. (1) Children with severe physical or mental disabilities;
   2. (2) Brain and spinal injured patients;
   3. (3) Ventilator-dependent patients; or
   4. (4) Other specialized services.
3. (c) The department shall determine the rate of reimbursement utilizing cost documentation submitted by the NF which clearly identifies the cost of the atypical care.

4. (d) The rate described in (c) above shall:

   1. (1) Include routine care costs, ancillary costs, and capital costs;
   2. (2) Take into consideration any additional amount necessary to assure access to necessary and appropriate services for New Hampshire medicaid residents with specialized care needs; and
   3. (3) Be exempt from comparative cost and occupancy limits.

5. (e) In order to qualify as an NF of atypical care, the NF shall make application in writing which:

   1. (1) Requests to be considered an NF of atypical care;
   2. (2) Describes the care or services to be provided; and
   3. (3) Documents the costs of such care.
6. (f) The department shall determine if an NF is qualified to provide and be paid for atypical care based on documentation submitted by the NF, and on whether there is a documented need for these services as determined by the availability of such services in the locality.
7. (g) Applications for approval of atypical care NFs which have been denied may be appealed pursuant to He-E 806.41.

Source. #8547, eff 1-24-06 (formerly He-W 593.38); ss by #10474, 1-24-14; ss by #14020, eff 7-10-24