1. (a) In-home supports shall be available to any individual birth through the age of 21 who lives at home with his or her family, and who:

   1. (1) Is found eligible for services by an area agency pursuant to:

      1. a. He-M 503.05 for individuals aged 3 to 21; or
      2. b. He-M 510 for individuals under the age of 3;
   2. (2) Is found eligible for Medicaid by the department pursuant to applicable rules in He-W 600 and He-W 800;
   3. (3) Has not graduated or exited the school system;

   4. (4) Has 2 or more factors specific to the individual or a combination of at least one factor specific to the individual and one factor specific to the parent which complicate care of the individual or impede the ability of the care-giving parent to provide care, including:

      1. a. The following factors specific to the individual:

         1. 1. Lack of age appropriate awareness of safety issues so that constant supervision is required;
         2. 2. Destructive or injurious behavior to self or others;
         3. 3. Inconsistent sleeping patterns or sleeping less than 6 hours per night and requiring supervision when awake; or

         4. 4. Any other condition that impedes the ability of the:

            1. (i) Care-giving parent to provide care; or
            2. (ii) Individual to participate in local community childcare or activity programs without support(s); or

      2. b. The following factors specific to the parent:

         1. 1. Care responsibilities for other family members with disabilities or health problems;
         2. 2. Age of either parent being less than 18 years or above 59;

         3. 3. Physical or mental health condition which impedes the ability of the care-giving parent to provide care;

            4 Founded child neglect or abuse as determined by a district court pursuant to RSA 169-C:21; or

         4. 5. Availability of only one parent for care-giving; and

   5. (5) Is determined by the department to meet institutional level of care as demonstrated by requiring one of the following:

      1. a. Services on a daily basis for:

         1. 1. Performance of basic living skills;
         2. 2. Intellectual, communicative, behavioral, physical, sensory motor, psychosocial, or emotional development and well-being;
         3. 3. Medication administration; or

         4. 4. Medical monitoring or nursing care by a licensed professional person such as:

            1. (i) A registered nurse;
            2. (ii) A licensed practical nurse;
            3. (iii) A physical therapist;
            4. (iv) An occupational therapist;
            5. (v) A speech pathologist; or
            6. (vi) An audiologist; or
      2. b. Services on a less than daily basis as part of a planned transition to more independence or to prevent circumstances that could necessitate more intrusive and costly services.
2. (b) To obtain determination of home and community based services waiver eligibility, in addition to the eligibility letter pursuant to He-M 503.05 or 510, the area agency shall complete and submit to the bureau a “NH Bureau of Developmental Services Functional Screen for Waiver Services” form (May 2013) and a “Bureau of Developmental Services In-Home Supports Waiver Individual/Parent Factors Form” (April 2022) within 3 business days of the eligibility determination made in accordance with He-M 524.03(a)(1)-(4) above.

3. (c) A person shall not be eligible for services under He-M 524 if he or she is:

   1. (1) Not living with his or her family; or
   2. (2) Receiving services under another home and community based Medicaid waiver.
4. (d) The bureau shall deny in-home supports if it determines that the provision of services will result in the loss of federal financial participation for such services.

Source. #7891, eff 5-20-03; ss by #9927, INTERIM, eff 5-21-11, EXPIRES: 11-17-11; ss by #10027, eff 11-17-11; ss by #13397, eff 6-18-22