1. (a) An applicant, parent, or guardian may request a waiver of specific services as outlined in He-M 520 by completing and submitting to the department, bureau of special medical services form titled “Department of Health and Human Services, Bureau of Special Medical Services Waiver for Services” ( December 2018)”.
2. (b) A completed waiver request form shall be signed by the applicant, parent, guardian, or provider indicating agreement with the request.

3. (c) The request for a waiver shall be granted by the commissioner or his or her designee within 30 days if:

   1. (1) The alternative proposed by the applicant, recipient, parent, or guardian meets the objective or intent of the rule;
   2. (2) The alternative proposed does not negatively impact the health or safety of the household or recipient;
   3. (3) The alternative proposed does not affect the quality of services to a recipient; and
   4. (4) All other TPL service requests have been exhausted or denied.

4. (d) A waiver request shall be submitted to:

   Department of Health and Human Services

   Office of Special Medical Services

   State Office Park South

   129 Pleasant Street, Thayer Building

   Concord, NH 03301

5. (e) No provision or procedure prescribed by statute shall be waived.
6. (f) The determination on the request for a waiver shall be made within 30 days of the receipt of the request.
7. (g) Waivers shall be granted in writing and remain in effect for the duration of the recipient’s current eligibility.
8. (h) Waivers shall end with the closure of the related program or service.

Source. #9748-A, eff 7-1-10; ss by #12558, INTERIM, eff 6-26-18, EXPIRED: 12-24-18 New. #12699, eff 12-28-18