1. (a) All HCBS waiver services provided shall be specifically tailored to, and provided in accordance with, the individual’s needs, interests, competencies, and lifestyle as described in the individual’s service agreement.

2. (b) Services provided pursuant to He-M 517 shall be:

   1. (1) Designed to maintain and enhance each individual’s natural supports;
   2. (2) Responsive to the individual’s changing needs and choices within the limitations of federal and state laws and rules and the HCBS waiver;
   3. (3) Provided only after the informed consent of the individual or their guardian or representative;
   4. (4) Free from conflict in accordance with He-M 503 or He-M 522;
   5. (5) Delivered by any willing and qualified provider agency or provider that is freely chosen by the individual or individual’s guardian or representative and who meets the criteria in He-M 504.03, He-M 504.04, and He-M 504.11; and
   6. (6) Provided in accordance with He-M 310.
3. (c) The services identified in (d)-(s) below shall be fundable in accordance with the HCBS waiver services if such services are identified within an individual’s service agreement.

4. (d) Service coordination services shall:

   1. (1) Be provided pursuant to He-M 503 or He-M 522;

   2. (2) Include the following:

      1. a. Coordination and facilitation to assist individuals in gaining access to needed services and resources, as well as needed medical, social, educational, and other services, regardless of funding source, as delineated in the service agreement, including:

         1. 1. System navigation including identifying, providing information about, and assisting families to access available services as well as community resources;
         2. 2. Person-centered service planning including coordination and facilitation of services and the development of a service agreement pursuant to He-M 503.09 and He-M 503.10 or He-M 522.10 and He-M 522.11;
         3. 3. Monitoring and ongoing review of services and individual outcomes, in accordance with He-M 503.10 or He-M 522.11 to include assessing and reassessing service needs, goals and, outcomes;
         4. 4. Monitoring of services for quality in accordance with He-M 503.10 or He-M 522.11;
         5. 5. Monitoring to ensure health and welfare in accordance with He-M 503.10 or He-M 522.11; and
         6. 6. Assistance in identifying available provider agencies and providers;
      2. b. Referral to the bureau for the redetermination of the individual’s continued need for HCBS waiver services pursuant to He-M 503 or He-M 522 and He-M 517.03;
      3. c. Twenty-four hour access, 7 days a week pursuant to He-M 504.03;
      4. d. Monitoring to ensure that documentation is maintained to demonstrate service coordination service provisions;
      5. e. Gathering of documentation from provider agencies to aid in person-centered service planning and in creating an individual’s service agreement in accordance with He-M 503.10 or He-M 522.11;
      6. f. Participating in transition planning; and
      7. g. Providing advocacy education and skill development to the individual, their family, and their representative or guardian; and
   3. (3) Be reimbursed at a monthly rate.

5. (e) Residential habilitation services shall:

   1. (1) Be provided pursuant to He-M 1001, He-M 525, or He-M 521, as applicable;

   2. (2) Include individually tailored supports to assist with the acquisition, retention, or improvement of community-based living skills including but not limited to:

      1. a. Meal preparation;
      2. b. Eating;
      3. c. Bathing;
      4. d. Dressing;
      5. e. Personal hygiene;
      6. f. Medication management;
      7. g. Community inclusion;
      8. h. Transportation;
      9. i. Social and leisure skills; and
      10. j. Adaptive skill development;
   3. (3) Include assistance to the individual to enable them to reside in the least restrictive setting most appropriate to their needs;
   4. (4) Be provided in the home or outside of the home;
   5. (5) Be reimbursed at a daily rate;
   6. (6) Be certified pursuant to He-M 1001, except as allowed by (7) below.
   7. (7) Be licensed by the bureau of health facilities administration in accordance with RSA 151:2, I, (e) and He-P 814, in addition to being certified pursuant to He-M 1001, if a community residence serves 4 or more people;
   8. (8) Not be required to be certified as a community residence pursuant to He-M 1001 when the residence is funded under the home and community-based care waiver, provides services to persons with acquired brain disorders, and is licensed as a supported residential care facility or a residential treatment and rehabilitation facility under RSA 151:2, I, (e);
   9. (9) Be certified pursuant to He-M 521.09 when residential habilitation services are provided in the family home of an individual who is 18 years of age or older, as described in He-M 521.03; and
   10. (10) Be certified pursuant to He-M 525 for services provided through a participant directed and managed services method of delivery.

6. (f) Community participation services shall:

   1. (1) Be provided in accordance with He-M 507;

   2. (2) Include the following as outlined in the individual’s service agreement:

      1. a. Instruction and assistance to learn, attain, improve, or maintain:

         1. 1. Social and safety skills in different community settings;
         2. 2. Decision-making regarding choice of and participation in community activities;
         3. 3. Life skills as applied to community-based activities, such as purchasing items and managing personal funds;
         4. 4. Good nutrition and healthy lifestyle;
         5. 5. Self-advocacy and rights and responsibilities as citizens; and
         6. 6. Any other skill identified by the individual or guardian during service planning and related to the individual’s participation in, or contribution to, their community;
      2. b. Supports to identify and develop the individual’s interests and capacities related to securing employment opportunities, including internships;
      3. c. Services related to job development and on-the-job training;
      4. d. Assistance in finding and maintaining volunteer positions;
      5. e. Supports related to enabling the individual to explore, and participate in, a wide variety of community activities and experiences in settings that are available to the general public; and
      6. f. Transportation related to community participation services, including travel from the individual’s residence to locations where the community participation service activities are taking place;

   3. (3) Exclude employment or volunteer positions where the individual is:

      1. a. Being solely supported by persons who are not providers; and
      2. b. Not receiving any services from a provider agency at those locations; and
   4. (4) Be reimbursed at a quarter hour rate.

7. (g) Supported employment services shall:

   1. (1) Be provided in accordance with He-M 518;

   2. (2) Be available to any individual who:

      1. a. Has a goal or desired outcome related to employment; and
      2. b. Is not authorized and funded by the NH department’ of education’s bureau of vocational rehabilitation for the same supported employment service;

   3. (3) Consist of assistance provided to individuals to:

      1. a. Improve or maintain their skills in employment activities; or
      2. b. Enhance their social and personal development or well-being within the context of vocational goals;
   4. (4) Include referral, evaluation, and consultation for adaptive equipment, environmental modifications, communications technology or other forms of assistive technology, and educational opportunities related to the individual’s employment services and goals;
   5. (5) When combined with another employment service, transportation and training in accessing transportation, as appropriate, to and from work; and
   6. (6) Be reimbursed at a quarter hour rate.

8. (h) Respite care services shall:

   1. (1) Be provided pursuant to He-M 513;
   2. (2) Consist of the provision of short-term assistance and care for individuals unable to care for themselves because of the absence or need for relief of the family who lives with and normally provides care for the individual;
   3. (3) Be provided in or out of an individual’s home;
   4. (4) Not exceed 20% of an individual’s total funding for services when provided through a participant directed and managed program as outlined in He-M 517.07 below and He-M 525;
   5. (5) Be authorized by the bureau in excess of the limitation in (4) above upon written request which shall include documentation supporting the need and the correlation of the request to the individual’s service agreement; and
   6. (6) Be reimbursed at a quarter hour rate.

9. (i) Environmental and vehicle modification services shall:

   1. (1) Include modifications or adaptations and maintenance thereof to the individual’s home environment including:

      1. a. Installation of ramps;
      2. b. Installation of grab bars;
      3. c. Widening of doorways to accommodate the participant’s wheelchair or other mobility access equipment; and
      4. d. Other adaptations authorized by the bureau that are necessary to ensure the health and safety of the individual or that are needed to accommodate the medical equipment and supplies that are necessary for the welfare of the individual;

   2. (2) Include modifications or adaptations and maintenance thereof to the vehicle used by the individual in order to enable them to:

      1. a. Travel in greater safety;
      2. b. Access the community; and
      3. c. Carry out activities of daily living;
   3. (3) Comply with applicable state and local building and vehicle codes;
   4. (4) Not exceed $2500 when used for outdoor fencing to support individuals with unsafe wandering or running behaviors; and
   5. (5) Be authorized by the bureau in excess of the limitation in (4) above upon written request which shall include documentation supporting the need and the correlation of the request to the individual’s service agreement.

10. (j) Environmental and vehicle modification services shall not cover:

    1. (1) Improvements that are of general utility and do not have direct or medical remedial benefit to the individual;
    2. (2) Adaptations which add to the square footage of the home except when necessary to complete an adaptation;
    3. (3) The purchase or lease of a vehicle;
    4. (4) Regularly scheduled upkeep and maintenance of a vehicle;
    5. (5) Electrical or plumbing work that is beyond what is required to support the authorized adaptation; and
    6. (6) Electrical or plumbing work for which the proposed contractor is unable to state, in writing, that the proposed adaptation can be done within the current electrical or plumbing capacity of the home.

11. (k) Crisis response services shall:

    1. (1) Consist of direct consultation, clinical evaluation, or support to an individual who is experiencing a behavioral, emotional, or medical crisis in order to reduce the likelihood of harm to the person or others and to assist the individual to return to their pre-crisis status;
    2. (2) Include training and staff development related to the needs of the individual;
    3. (3) Include on-call staff for the direct support of the individual in crisis;
    4. (4) Be authorized for a period of up to 6 months;
    5. (5) Be reimbursed at a quarter hour rate; and
    6. (6) Be authorized by the bureau in excess of the limitation in (4) above upon written request which shall include documentation supporting the need and the correlation of the request to the individual’s service agreement.

12. (l) Community support services shall:

    1. (1) Be available for an individual who has developed, or is trying to develop, skills to live independently within the community;

    2. (2) Consist of assistance, excluding room and board, provided to an individual to:

       1. a. Improve or maintain their skills in basic daily living and community integration; and
       2. b. Enhance their personal development and well-being;
    3. (3) Not exceed 30 hours per week;
    4. (4) Be provided for up to 24 consecutive months while an individual is residing with their family;
    5. (5) Be authorized by the bureau in excess of the limitation in (3) and (4) above upon written request which shall include documentation supporting the need and the correlation of the request to the individual’s service agreement; and
    6. (6) Be reimbursed at a quarter hour rate.

13. (m) Assistive technology shall:

    1. (1) Include an item, piece of equipment, certification and training of service animal, or product system, used to increase, maintain, or improve functional capabilities of an individual, including, but not limited to, the following:

       1. a. Devices, controls, or appliances, specified in the individual service agreement that enable the individual to increase their ability to perform activities of daily living, or perceive, control, or communicate with the environment in which they live;;
       2. b. The evaluation of the assistive technology needs of an individual, including a functional evaluation of the impact of the provision of appropriate assistive technology and appropriate services to the individual;
       3. c. Purchasing, leasing, or otherwise providing for the acquisition of assistive technology or devices;
       4. d. Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices;
       5. e. Coordination and use of necessary therapies, interventions, or services associated with other services in the service agreement;
       6. f. Training or technical assistance for the individual or the individual’s family members, guardians, advocates, or authorized representatives;
       7. g. Training or technical assistance for professional or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of an individual; and
       8. h. Training and certification of a service animal, defined in federal regulations implementing the Americans with Disabilities Act, 28 C.F.R. § 36.104 as “service animal means any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability. Other species of animals, whether wild or domestic, trained or untrained, are not service animals for the purposes of this definition. The work or tasks performed by a service animal must be directly related to the individual's disability.";
    2. (2) Include adaptive equipment which shall be items of durable and non-durable medical equipment necessary to address the individual’s functional limitations;
    3. (3) Not exceed $10,000 over the course of 5 years; and
    4. (4) Be authorized by the bureau in excess of the limitation in (3) above upon written request which shall include documentation supporting the need and the correlation of the request to the individual’s service agreement.

14. (n) Specialty services shall:

    1. (1) Be available to individuals whose medical, behavioral, therapeutic, health, or personal needs require services that are particularly designed to address the unique conditions and aspects of their developmental disabilities or acquired brain disorders;

    2. (2) Consist of one or more of the following:

       1. a. Assessment;
       2. b. Consultation;
       3. c. Design, development, and provision of services;
       4. d. Training and supervision of staff and providers; and
       5. e. Evaluation of service outcomes; and
    3. (3) Be reimbursed at a quarter hour rate or at cost when for a consultation.

15. (o) Community integration services shall:

    1. (1) Be services designed to support, enhance, or enable an individual’s level of functioning, independence, and life activities, to promote health and wellness as well as reduce or eliminate the activity limitations and restrictions to participation in life situations caused by a disability shall include, but not be limited to the following:

       1. a. Water safety training;
       2. b. Community based camperships; and
       3. c. A pass or membership for admission to community-based activities only when needed to address assessed needs;
    2. (2) When including community-based activity passes, be purchased as day passes or monthly passes, whichever is the most cost effective;
    3. (3) Not exceed $8,000 annually;
    4. (4) Be authorized by the bureau in excess of the limitation in (3) above upon written request which shall include documentation supporting the need and the correlation of the request to the individual’s service agreement; and
    5. (5) Require a licensed healthcare practitioner’s recommendation when any single community integration service, other than a campership, is over $2,000.

16. (p) Individual goods and services shall:

    1. (1) Include equipment or supplies that address an identified need in the service agreement, and meet at least one of the following requirements:

       1. a. The good or service decreases the need for other Medicaid services;
       2. b. The good or service promotes inclusion in the community; or
       3. c. The good or service increases the individual's safety in the home environment;

    2. (2) Include payment through the home and community-based services waiver if:

       1. a. The individual does not have the funds to purchase the item or service; or
       2. b. The item or service is not covered through other sources;
    3. (3) Not exceed $1,500 annually;
    4. (4) Be authorized by the bureau in excess of the limitation in (3) above upon written request which shall include documentation supporting the need and the correlation of the request to the individual’s service agreement;
    5. (5) Have an anticipated finite period of time to be utilized; and
    6. (6) Include a determination on the frequency of purchase of individual goods and services in accordance with the documented continued need of the item and the ability of the item to continue to meet that need.

17. (q) Non-medical transportation shall:

    1. (1) Be services designed specifically to improve the individual’s and the caregiver's ability to access community activities within their own community in response to needs identified through the individual's service agreement, including, but not limited to:

       1. a. Orientation service using other services or supports for safe movement from one place to another;
       2. b. Travel training such as supporting the individual and family in learning how to access and use informal and public transport for independence and community integration;
       3. c. Transportation service provided by different modalities, including public and community transportation, taxi services, transportation specific to prepaid transportation cards, mileage reimbursement, volunteer transportation, and non-traditional transportation providers; and
       4. d. Prepaid transportation vouchers and cards;

    2. (2) Be limited to:

       1. a. $5,000 annually; or

       2. b. $10,000 annually for individuals who require specialized transportation such as a vehicle that:

          1. 1. Can accommodate a wheelchair or similar;
          2. 2. Has lift capabilities; or
          3. 3. Allows for the individual to not be within reach of the driver;
    3. (3) Be authorized by the bureau in excess of the limitations in (2)(a)-(b) above upon written request which shall include documentation supporting the need and the correlation of the request to the individual’s service agreement;

    4. (4) Be limited to transportation needed:

       1. a. To access a HCBS waiver service that is included in the individual’s service agreement; or
       2. b. To access other activities and resources identified in the individual’s service agreement; and
    5. (5) Not be available to individuals under the age of 16 for public transportation expenses.

18. (r) Personal emergency response services (PERS) shall:

    1. (1) Consist of smart technology devices that enable individuals to summon help in an emergency including but not limited to:

       1. a. Wearable or portable devices that allow for safe mobility;
       2. b. Response systems that are connected to the individual’s telephone and programmed to signal a response center when activated;
       3. c. Staffed and monitored response systems that operate 24 hours a day, 7 days a week;
       4. d. Any device that informs of elopement; and
       5. e. Monthly expenses that are affiliated with maintenance contracts or agreements to maintain the operations of the device or item;
    2. (2) Include non-smart technology items, such as seatbelt release covers, ID bracelets, and GPS devices;
    3. (3) Not exceed $2,000 annually;
    4. (4) Be authorized by the bureau in excess of the limitation in (3) above upon written request which shall include documentation supporting the need and the correlation of the request to the individual’s service agreement; and
    5. (5) Be authorized as part of a positive behavior plan pursuant to He-M 310 when the device is restrictive.

19. (s) Wellness coaching shall:

    1. (1) Include planning, directing, coaching, and mentoring individuals with disabilities in community based, inclusive exercise activities in accordance with the recommendations of a licensed recreational therapist or a certified personal trainer;
    2. (2) Include specific goals in the individual’s service agreement which are developed by a wellness coach, including activities that are carried over into the individual’s home and community;
    3. (3) Consist of demonstration by a wellness coach on exercise techniques and form to include observation of individuals and explanation to them of corrective measures necessary to improve their skills;
    4. (4) Include collaboration between a wellness coach and the individual, their family and other caregivers, and with other health and wellness professionals as needed;
    5. (5) Not exceed $5,000 annually; and
    6. (6) Be authorized by the bureau for amount in excess of the limitation in (5) above by written request, which shall include the recommendation of a licensed professional and documentation supporting the need and the correlation of the request to the individual’s service agreement.

20. (t) Removable prosthodontic services shall:

    1. (1) Assist individuals as a means to prevent functional limitations in order to support community integration and avoid isolation or institutionalization and when, if not otherwise provided:

       1. a. The individual’s health would be compromised through reduced food options and result in restrictive nutritional intake, impacting overall health; or
       2. b. When considerations interfere with supported employment or social development;

    2. (2) Include:

       1. a. Complete dentures, including immediate prosthetic appliances and routine post-delivery care;
       2. b. P artial dentures, including immediate prosthetic appliances and routine post-delivery care;
       3. c. Adjustments to dentures;
       4. d. Repairs to complete and partial dentures;
       5. e. Denture rebase procedures; and
       6. f. Denture reline procedures;
    3. (3) Be included in the individual’s service agreement;
    4. (4) Not exceed $1,500 annually;
    5. (5) Not cover dentures more than once in a 5 year period;
    6. (6) Not be available to individuals under the age of 21 that are not otherwise covered by the Medicaid state plan;
    7. (7) Be authorized by the department in excess of the limitation in (4) and (5) above due to medical necessity through written request, which shall include documentation to support the identified need and how it correlates the individual’s service agreement; and
    8. (8) Be overseen by New Hampshire’s prepaid ambulatory health plan as defined in 42 CFR §438.2.

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; amd by #9370, eff 1-24-09; ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24