1. (a) “Department” means the New Hampshire (NH) department of health and human services.
2. (b) “Early and periodic screening, diagnosis and treatment (EPSDT) services” means a program, as defined in 42 CFR 440.40(b), designed to provide preventative health care, diagnostic services, and early detection and treatment of disease or abnormalities to medicaid eligible individuals under age 21.
3. (c) “Medicaid” means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.

4. (d) “Medical” means related to the following:

   1. (1) Treatment of disease;
   2. (2) Maintenance of health; or
   3. (3) Prevention, alleviation, or curing of disease.
5. (e) “Medically necessary” means reasonably calculated to prevent, diagnose, correct, cure, alleviate, or prevent the worsening of conditions that endanger life, cause pain, result in illness or infirmity, threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and no other equally effective course of treatment is available or suitable for the EPSDT recipient .
6. (f) “Periodicity schedule” means a regularly recurring schedule of preventive health care, dental care, or screening services as determined by standards of practice.
7. (g) “Primary care physician” means the physician who routinely provides health care to the recipient.
8. (h) “Recipient” means an individual who is eligible for and is receiving medical assistance under the medicaid program.
9. (i) “Title XIX program” means the joint federal-state program described in Title XIX of the Social Security Act and administered in NH by the department under the medicaid program.
10. (j) “Title XXI” means the joint federal-state program described in Title XXI of the Social Security Act and administered in NH by the department under the medicaid program.
11. (k) “Treating physician” means the physician who is managing a present illness or condition, in conjunction with or aside from the recipient’s primary care physician.

Source. (See Revision Note at chapter heading He-W 500); ss by #5532, eff 12-17-92, EXPIRED: 12-17-98 New. #6940, eff 1-30-99; ss by #8782, eff 1-1-07; amd by #10139, eff 7-1-12; ss by #10829, eff 5-19-15; ss by #14383, eff 9-20-25, EXPIRES: 9-20-35