New Hampshire SB 612: relative to clinical eligibility criteria for nursing facility and home and community based care.

Bill Text

SB 612-FN - AS INTRODUCED

2026 SESSION

 26-2207

 05/08

SENATE BILL 612-FN

AN ACT relative to clinical eligibility criteria for nursing facility and home and community based care.

SPONSORS: Sen. Avard, Dist 12

COMMITTEE: Health and Human Services

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ANALYSIS

 This bill modifies long-term care eligibility by adding mobility to the list of activities of daily living. The bill also requires the department of health and human services to obtain a determination of an applicant’s need for long term care from the applicant or participant’s primary care physician, physician assistant, or advanced practice registered nurse, and to consider information from other health care providers.

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Explanation: Matter added to current law appears in bold italics.

 Matter removed from current law appears [in brackets and struckthrough.]

 Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

 26-2207

 05/08

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Twenty-Six

AN ACT relative to clinical eligibility criteria for nursing facility and home and community based care.

Be it Enacted by the Senate and House of Representatives in General Court convened:

 1 Long-Term Care; Eligibility. Amend RSA 151-E:3 to read as follows:

 151-E:3 Eligibility.

 I. A person is [medicaid] Medicaid eligible for nursing facility services or Medicaid home and community-based care waiver services if the person is:

 (a) Clinically eligible for nursing facility care because the person requires 24-hour care for one or more of the following purposes:

 (1) Medical monitoring and nursing care when the skills of a licensed medical professional are needed to provide safe and effective services;

 (2) Restorative nursing or rehabilitative care with patient-specific goals;

 (3) Medication administration by oral, topical, intravenous, intramuscular, or subcutaneous injection, or intravenous feeding for treatment of recent or unstable conditions requiring medical or nursing intervention; or

 (4) Assistance with 2 or more activities of daily living [involving] which include but are not limited to eating, toileting, transferring, mobility, bathing, dressing, and continence. For purposes of this section “mobility” means the need to be physically steadied, assisted, or guided in ambulation, or unable to propel a wheelchair alone or appropriately and require the assistance of another person; and

 (b) Financially eligible as either:

 (1) Categorically needy, as calculated pursuant to rules adopted by the department under RSA 541-A; or

 (2) Medically needy, as calculated pursuant to rules adopted by the department under RSA 541-A.

 II. Skilled professional medical personnel employed by or designated to act on behalf of the department shall determine clinical eligibility in accordance with the criteria in subparagraph I(a). The clinical eligibility determination shall be based upon an assessment tool, approved by the department, performed by skilled professional medical personnel employed by the department, or by an individual with equivalent training designated by the department. The department shall train all persons performing the assessment to use the assessment tool. For the purposes of this section, "skilled professional medical personnel" shall have the same meaning as in 42 C.F.R. section [432.50(d)(1)(ii)] 432.2.

 II-a. Subject to written approval by the Center for Medicare and Medicaid Services, financial eligibility rules in paragraph II shall include eligibility if the person's countable income is at or below the nursing facility special income standard, as defined in 42 C.F.R. 435.236, for the Medicaid program or the person incurs allowable medical expenses each month, including the anticipated cost of waiver services, which when deducted from the individual's income would reduce the individual's income to an amount that is no higher than the nursing facility special income standard. The department shall submit a request for such approval within 30 days of the effective date of this paragraph.

 III. [Repealed.]

 IV. If the skilled professional medical personnel employed by or designated to act on behalf of the department are unable to determine that an applicant is eligible following the clinical assessment tool pursuant to paragraph II, the [skilled professional medical personnel] department shall obtain a determination for the need for long-term care from the applicant’s primary care physician, physician assistant, or advanced practice registered nurse. The department shall request information from and give substantial weight to other clinical information provided by the applicant's [physician or nurse practitioner, including, but not limited