1. (a) “Acquired brain disorder” means a disruption in brain functioning that:

   1. (1) Is not congenital or caused by birth trauma;
   2. (2) Presents a severe and life-long disabling condition which significantly impairs a person’s ability to function in society;
   3. (3) Occurs prior to age 60;

   4. (4) Is attributable to one or more of the following reasons:

      1. a. External trauma to the brain as a result of:

         1. 1. A motor vehicle incident;
         2. 2. A fall;
         3. 3. An assault; or
         4. 4. Another related traumatic incident or occurrence;

      2. b. Anoxic or hypoxic injury to the brain such as from:

         1. 1. Cardiopulmonary arrest;
         2. 2. Carbon monoxide poisoning;
         3. 3. Airway obstruction;
         4. 4. Hemorrhage; or
         5. 5. Near drowning;
      3. c. Infectious diseases such as encephalitis and meningitis;
      4. d. Brain tumor;
      5. e. Intracranial surgery;
      6. f. Cerebrovascular disruption such as a stroke;
      7. g. Toxic exposure; or
      8. h. Other neurological disorders, such as Huntington’s disease or multiple sclerosis, which predominantly affect the central nervous system resulting in diminished cognitive functioning and ability; and

   5. (5) Is manifested by one or more of the following:

      1. a. Significant decline in cognitive functioning and ability; or

      2. b. Deterioration in:

         1. 1. Personality;
         2. 2. Impulse control;
         3. 3. Judgment;
         4. 4. Modulation of mood; or
         5. 5. Awareness of deficits.
2. (b) “Amendment” means any change to the personal profile, provider agency, or provision of services, including the amount, scope, type, frequency, or duration, within a service agreement.
3. (c) “Applicant” means any person who requests services pursuant to He-M 522.04.
4. (d) “Area” means “area” as defined in RSA 171-A:2, I-a, namely, “a geographic region established by rules adopted by the commissioner for the purpose of providing services to developmentally disabled persons.” This term includes “region”.
5. (e) “Area agency” means “area agency” as defined in RSA 171-A:2, I-b.
6. (f) “Area agency director” means that person who is appointed as executive director or acting executive director of an area agency by the area agency’s board of directors.
7. (g) “Assistive technology” means technology designed to be utilized in an “assistive technology device” as defined in 29 U.S.C. section 3002(4) or “assistive technology service” as defined in 29 U.S.C. section 3002(5).

8. (h) “Brain injury community supports” means services administered through the Brain Injury Association of New Hampshire that:

   1. (1) Are provided to persons with an acquired brain disorder who are eligible for services pursuant to He-M 522.03(a) but do not meet the eligibility criteria in He-M 517.03(a) for home and community-based care; and

   2. (2) Include, at a minimum the following services when such services are not reimbursable by medicaid or other insurance:

      1. a. Home modification;
      2. b. Respite service;
      3. c. Assistive technology;
      4. d. Specialized equipment;
      5. e. Transportation;
      6. f. Short-term financial assistance, such as for utilities or rent;
      7. g. Therapeutic evaluations; and
      8. h. Other similar limited or nonrecurring services necessary for an individual to live as safely and independently as possible in their community.
9. (i) “Bureau” means the bureau of developmental services of the department of health and human services.
10. (j) “Bureau administrator” means the chief administrator of the bureau of developmental services.
11. (k) “Commissioner” means the commissioner of the department of health and human services or their designee.
12. (l) “Comprehensive risk assessment” means an evaluation administered pursuant to He-M 522.10 (m)(11) using evidence-based tools to evaluate an individual’s behaviors and determine the potential risks to the individual or others posed by said behaviors.
13. (m) “Days” means calendar days unless otherwise specified.
14. (n) “Department” means the New Hampshire department of health and human services.

15. (o) “Developmental disability” means “developmental disability” as defined in RSA 171-A:2, V, namely, a disability:

    1. (1) “Which is attributable to an intellectual disability, cerebral palsy, epilepsy, autism, or a specific learning disability, or any other condition of an individual found to be closely related to an intellectual disability as it refers to general intellectual functioning or impairment in adaptive behavior or requires treatment similar to that required for persons with an intellectual disability”; and
    2. (2) “Which originates before such individual attains age 22, has continued or can be expected to continue indefinitely, and constitutes a severe disability to such individual’s ability to function normally in society.”
16. (p) “Guardian” means a person appointed pursuant to RSA 463 or RSA 464-A, or the parent of an individual under the age of 18 whose parental rights have not been terminated or limited by law.

17. (q) “Health Risk Screening Tool (HRST)” means the 2015 edition of the Health Risk Screening Tool, available as noted in Appendix A, which is a web-based rating instrument used for performing health risk screenings on individuals in order to:

    1. (1) Determine an individual’s vulnerability regarding potential health risks; and
    2. (2) Enable the early identification of health issues and monitoring of health needs.
18. (r) “Home and community-based waiver services (waiver services)” means the services defined and funded pursuant to New Hampshire’s agreement with the federal government, known as the Acquired Brain Disorder Waiver, pursuant to the authority of section 1915(c) of the Social Security Act, which allows the federal funding of long-term care services in non-institutional settings for persons who have an acquired brain disorder.
19. (s) “Individual” means a person with an acquired brain disorder.
20. (t) "Informed consent" means a decision made voluntarily by an individual or applicant for services or, where appropriate, such person's legal guardian or representative, after all relevant information necessary to making the choice has been provided, when the person understands that they are free to choose or refuse any available alternative, when the person clearly indicates or expresses their choice, and when the choice is free from all coercion.
21. (u) “Intellectual disability” means “intellectual disability” as defined in RSA 171-A:2, XI-a, namely, “significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior, and manifested during the developmental period. A person with an intellectual disability may be considered mentally ill provided that no person with an intellectual disability shall be considered mentally ill solely by virtue of his or her intellectual disability.”
22. (v) “Participant directed and managed services” means a method of service delivery provided pursuant to He-M 525.
23. (w) “Person-centered service planning” is an individual-directed, positive approach to the planning and coordination of a person’s services and other supports based on the individual’s aspirations, needs, preferences, and goals.
24. (x) “Personal profile” means a narrative description that includes a personal statement from the individual and those who know them best that summarizes the individual’s strengths and capacities, communication and learning style, challenges, needs, interests, and any health concerns, as well as the individual’s hopes and dreams.
25. (y) “Provider” means a person receiving any form of remuneration for the provision of services to an individual.
26. (z) “Provider agency” means an agency or an independent provider that is established to provide services to individuals and meets the criteria in He-M 504.

27. (aa) “Representative” means:

    1. (1) The parent or guardian of an individual under the age of 18;
    2. (2) The guardian of an individual 18 or over; or
    3. (3) A person who has power of attorney for the individual.
28. (ab) “Service” means any paid assistance to the individual in meeting their own needs provided through the developmental services system.
29. (ac) “Service agreement” means a written agreement between the individual, guardian, or representative and provider agencies, developed pursuant to He-M 522, that is prepared as a result of the person-centered service planning process and that describes the services that an individual will receive and constitutes an individual service agreement as defined in RSA 171-A:2, X.
30. (ad) “Service coordination agency” means a provider agency providing service coordination services to individuals, that meets the criteria in He-M 504.
31. (ae) “Service coordinator” means a provider who meets the criteria in He-M 522.09(b)-(d) and is chosen by an individual and their guardian or representative to organize, facilitate, and document service planning and to negotiate and monitor the provision of the individual’s services.
32. (af) “Service planning meeting” means a gathering of 2 or more people, one of whom is the individual who receives services unless they choose not to attend, held to develop, review, add to, delete from, or otherwise change a service agreement.
33. (ag) “State of residence” means the “state of residence” as defined in 42 CFR 435.403.
34. (ah) “Supported decision-making” means “supported decision-making” as defined in RSA 464-D:4, VI.
35. (ai) “Supports intensity scale adult version ® (SIS-A ®)” means the 2023 edition of the Supports Intensity Scale, available as noted in Appendix A, which is an assessment tool intended to assist in service planning by measuring the individual’s support needs in the areas of home living, community living, lifelong learning, employment, health and safety, social activities, protection, and advocacy. The tool uses a formal rating scale to identify the type of supports needed, frequency of supports needed, and daily support time.
36. (aj) “Termination” means the cessation of a service by an area agency director with or without the informed consent of the individual or their guardian or representative.
37. (ak) “Withdrawal” means the choice of an individual or their guardian or representative to discontinue that individual’s participation in a service.

Source. #7120, eff 10-20-99; ss by #8974, INTERIM, eff 10-6-07, EXPIRED: 4-3-08 New. #9734, eff 6-25-10; ss by #12683, eff 11-30-18; ss by #14253, eff 5-22-25, EXPIRES: 5-22-35