1. (a) Requests for prior service authorization shall be made to the bureau electronically utilizing NH Easy via https://nheasy.nh.gov/#/, and shall include the service, amount, scope, frequency, and duration.
2. (b) To request prior service authorization of a change in covered services within a current authorization period, the service coordinator shall complete and submit, via NH Easy at https://nheasy.nh.gov/#/, updated information to reflect the change in the service, amount, scope, frequency, or duration.
3. (c) The bureau shall approve or deny requests for prior service authorization following determination and approval of the need for services pursuant to He‑M 517.03 and development of a service agreement pursuant to He-M 503.10 or He-M 522.11.
4. (d) If information submitted pursuant to (b) or (c) above, or similar information obtained at any other time by the bureau, indicates that an individual might no longer meet the criteria for home and community-based care specified in He-M 517.03(a)(3) a. or b., the bureau shall redetermine the individual’s eligibility pursuant to He-M 517.03(a)(3).

5. (e) Any request for an environmental or vehicle modification shall include:

   1. (1) Two cost estimates when the modification is in excess of $7,500 to include the following, as applicable to the modification:

      1. a. A breakdown of costs between labor and materials;
      2. b. A list of supplies and materials;
      3. c. Blueprints or scaled drawings, if applicable;
      4. d. The name(s) of any subcontractors that will be involved;
      5. e. Written confirmation of whether or not a building permit is required;
      6. f. A written statement if the individual or guardian, if applicable, prefers the more expensive bid over the other, to include an explanation of the preference;

   2. (2) If electrical or plumbing work is required to support the modification, then:

      1. a. A statement signed by the selected plumber or electrician stating that the requested modification can be done within the current electrical or plumbing capacity of the residence; and
      2. b. A copy of the selected electrician or plumber’s license;
   3. (3) A statement signed by the selected provider agency affirming knowledge of all applicable building codes and permitting requirements and affirming that any subcontractors involved in the work are appropriately licensed;
   4. (4) An agreement signed by the selected provider agency stating that reimbursement for the authorized service through the bureau shall be payment in full; and
   5. (5) A notarized written statement from the property owner granting permission to complete the project if the individual is not the owner of the residence.
6. (f) The bureau shall deny services through the HCBS waiver services if it determines that the provision of services will result in the loss of federal financial participation for such services.
7. (g) In every case of denial of a request for prior service authorization, the bureau shall notify the service coordinator, individual, guardian, or representative, in writing, of the decision and the reasons for the denial.

8. (h) Notification pursuant to (g) above shall include:

   1. (1) The specific rules that support, or the federal or state law that requires, the action;
   2. (2) An explanation of the individual’s right to request an appeal and the procedure and timelines set forth in He-M 517.12;

   3. (3) Notice that the individual has the right to have representation with an appeal by:

      1. a. Legal counsel;
      2. b. A relative;
      3. c. A friend; or
      4. d. Another spokesperson;
   4. (4) Notice that neither the area agency, service coordination agency, nor the bureau is responsible for the cost of representation; and
   5. (5) Notice of organizations that might offer assistance or representation to the individual, including pro bono or reduced fee assistance.

Source. #8424, eff 9-1-05 (from He-M 517.10); ss by #10454, eff 10-31-13; ss by #13988, eff 5-30-24 (formerly He-M 517.08)