All participating medical services clinics shall meet the following criteria in either (a) or (b) below:

1. (a) Medical services clinics that are not mobile immunization providers shall meet the following criteria:

   1. (1) Be composed of New Hampshire licensed practitioners who meet the provider requirements for the particular medical service being performed as set forth in He-W 511 through He-W 577;

   2. (2) Provide recipient care that is under the supervision of a licensed physician affiliated with the clinic which shall mean that:

      1. a. The physician is readily available to provide direction either by phone or in person;
      2. b. The physician has seen the recipient as a patient at least once and assesses the need for continuing care as necessary; and
      3. c. The physician assumes professional responsibility for the services provided to the recipient;
   3. (3) Provide medical care on an outpatient basis;
   4. (4) Be organized and operated independently from a hospital pursuant to 42 CFR 440.90;
   5. (5) Be an enrolled New Hampshire medicaid provider; and
   6. (6) Request and obtain prior authorization from the department before providing services which require prior authorization as specified in He-W 511 through He-W 577; or

2. (b) Medical services clinics that are mobile immunization providers shall meet the following criteria:

   1. (1) Be composed of, and provide immunizations by, New Hampshire licensed practitioners whose licensure allows them to provide immunizations;
   2. (2) Be under contract with, or have a current vaccine provider agreement with, the department’s division of public health services;
   3. (3) Provide immunizations to recipients in settings such as walk-in clinics, retail stores and outlets, pharmacies, and schools;
   4. (4) Provide immunizations as medicaid services only in those settings and for those types or ages of recipients addressed in the contract or agreement in (2) above;
   5. (5) Provide services “under the direction of a physician”, which means through standing orders or other indirect supervision where the physician is not necessarily on site but who assumes professional responsibility for the services provided to the recipient;
   6. (6) Affiliate with the directing physician through a contractual agreement or any other formal arrangement which obligates the physician to supervise the care provided to the recipient by the clinic;
   7. (7) Be organized and operated independently from a hospital pursuant to 42 CFR 440.90; and
   8. (8) Be an enrolled New Hampshire medicaid provider.

Source. (See Revision Note at chapter heading He-W 500); ss by #6133, eff 11-30-95; ss by #7825, eff 2-8-03; ss by #9860, eff 2-8-11, EXPIRED: 2-8-19 New. #12732, INTERIM, eff 2-22-19, EXPIRES: 8-21-19