Definitions

(a) “Beneficiary” means an individual determined eligible for the granite advantage health care program.

(b) “Commissioner” means the commissioner of the NH department of health and human services, or his or her designee.

(c) “Community engagement requirement” means a condition of continuing eligibility for the granite advantage health care program that requires beneficiaries to engage in 100 hours per calendar month in one or more community engagement activities.

(d) “Cure” means meeting the community engagement requirement by making up deficit hours, demonstrating good cause for deficit hours, or providing certification of an exemption status.

(e) “Dating violence” means violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim.

(f) “Deficit hours” means the number of hours below 100 hours that the beneficiary did not participate in community engagement activities in a calendar month.

(g) “Department” means the New Hampshire department of health and human services.

(h) “Disability” means disability as defined by the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act, or Section 1557 of the Patient Protection and Affordable Care Act.

( i ) “Disenrollment” means the termination of medicaid eligibility at the annual redetermination of a suspended beneficiary.

(j) “Domestic violence” means domestic violence as defined in RSA 631:2-b.

(k) “Granite advantage health care program (granite advantage)” means the granite advantage health care program established under RSA 126-AA which provides medicaid coverage to adults eligible under Title XIX of the Social Security Act 1902(a)(10)(A)( i )(VIII).

(l) “Good cause” means circumstances that prevented the beneficiary from meeting the community engagement requirement pursuant to He-W 837.10.

(m) “Homeless” means a situation in which an individual lacks a fixed, regular, and adequate nighttime residence such as living in a publicly or privately operated shelter, or living in a public or private location not meant for human habitation, and includes a situation in which an individual is in peril of losing his or her primary residence, no subsequent residence has been identified, and the individual lacks support networks to obtain permanent housing.

(n) “Immediate family member” means a spouse, child(ren), mother-in-law, father-in-law, parent(s), step-parent(s), step-child(ren), step-brother(s), step-sister(s), grandparent(s), grandchild(ren), brother(s), sister(s), legal guardian(s), daughter(s)-in-law, son(s)-in-law, brother(s)-in-law, sister(s)-in-law, and foster child(ren).

(o) “Licensed medical professional” means a physician, an advanced practice registered nurse (APRN), a behavioral health professional who is able to determine eligibility for community mental health services pursuant to He-M 401.04, a physician assistant, a licensed alcohol and drug counselor (LADC), a master of licensed alcohol and drug counselor (MLADC), nurse case manager, or a board-certified psychologist.

(q) “Medically frail” means a beneficiary, as defined in 42 CFR 440.315(f), with a disabling mental disorder, chronic substance use disorder (SUD), serious and complex medical condition, or a physical, intellectual, or developmental disability that significantly impairs the ability to perform one or more activities of daily living as certified by a licensed medical professional.

(r) “Noncompliant” means a status where a beneficiary failed to meet the 100 hour per calendar month community engagement requirement in a single month.

(s) “Redetermination” means the annual medicaid eligibility renewal process required by 42 CFR 435.916, He-W 606, and He-W 684.

(t) “Stalking” means engaging in a course of conduct directed at a specific person that would cause a reasonable person to fear for the person’s individual safety or the safety of others or suffer substantial emotional distress.

(u) “Sexual assault” means sexual assault as defined in RSA 632-A:4.

(v) “Voluntary” means a community engagement status in which a beneficiary is not required to participate in the community engagement requirement but chooses to do so.

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19