1. (a) Based on availability of funds, HCBS waiver services shall be available to any individual who:

   1. (1) Is found to be eligible for services by an area agency pursuant to He-M 503 or He-M 522;
   2. (2) Is found to be eligible for medicaid by the department pursuant to He-W 600 and He-W 800, as applicable;

   3. (3) Meets institutional level of care criteria as demonstrated by one of the following:

      1. a. A developmental disability that requires at least one of the following:

         1. 1. Services on a daily basis for:

            1. (i) Performance of basic living skills;
            2. (ii) Intellectual, physical, or psychological development and well-being;
            3. (iii) Medication administration and instruction in, or supervision of, self-medication by a licensed medical professional; or
            4. (iv) Medical monitoring or nursing care by a licensed professional person;
         2. 2. Services on a less than daily basis as part of a planned transition to more independence; or
         3. 3. Services on a less than daily basis but with continued availability of services to prevent circumstances that could necessitate more intrusive and costly services; or
      2. b. An acquired brain disorder that requires a skilled nursing facility level of care, which means requiring skilled nursing or skilled rehabilitative services on a daily basis; and
   4. (4) Agrees to make the appropriate payment toward the cost of care, as specified in He-M 517.13(c).
2. (b) To request initial determination of level of care as described in in He-M 517.03(a)(3) above, a “NH bureau of developmental services functional screen for waiver services” electronic form shall be submitted by the area agency via NH Easy, via https://nheasy.nh.gov/#/, within 5 business days of an individual’s decision to seek eligibility for HCBS waiver services.
3. (c) Individuals shall undergo an annual redetermination of the level of care criteria in He-M 517.03(a)(3) above.
4. (d) To request a redetermination of the level of care in He-M 517.03(a)(3) above, a “NH bureau of developmental services functional screen for waiver services” electronic form shall be submitted by the service coordinator via NH Easy, https://nheasy.nh.gov/#/ , not less than 30 days but not more than 45 days prior to expiration of the current level of care determination.
5. (e) The bureau shall send notification of the level of care determination in accordance with He-M 503.05 or He-M 522.06.
6. (f) The bureau shall deny services through the home and community-based waiver if it determines that the provision of services will result in the loss of federal financial participation for such services.

Source. #4315, eff 9-25-87; EXPIRED: 9-25-93 New. #6360, eff 10-23-96, EXPIRED: 10-23-04 New. #8195, INTERIM, eff 10-29-04, EXPIRED: 4-27-05 New. #8424, eff 9-1-05; ss by #9370, eff 1-24-09; ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24