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The Bureau of Mental Health Services (BMHS) will provide approval decisions for only those rules for which they have oversight responsibility, there is a waiver provision in the rule, and as designated by the Commissioner. Laws and statutes cannot be waived and entire rule or “global” waivers are outside of the scope of the BMHS to approve.

BMHS rules and the specific waiver provisions are: He-M 401 and 401.15; He-M 402 and 402.10; He-M 403 and 403.16; He-M 405 and 405.17; He-M 406 and 406.10; He-M 408 and 408.14; He-M 426 and 426.23; and He-M 1202 and 1202.12.

The following rules and the specific waiver provisions require additional review and approval the Office of Licensing and Certification: He-M 1002 and 1002.18; He-M 1004 and 1004.09; He-M 1005 and 1005.10: and He-M 1007 and 1007.13.

Prior Authorization: A Prior Authorization is required in order for the provider to exceed the service limits identified in rule, for example:

He-M 426.12 Individualized Resiliency and Recovery Oriented Services (IROS).

(p) Billing for functional support services provided to each individual, except for crisis intervention services, those who are served on an ACT team, and all functional support services provided to individuals eligible to receive children’s program services under He-M 401, shall be limited as follows:

(1) Individual therapeutic behavioral services, family support services, and medication support services shall be limited to a combined total of (10) units per day; and
(2) Group therapeutic behavioral services shall be limited to (10) units per day.

Supporting Documents: Additional documentation submitted with the waiver request in order to substantiate and support the approval decision includes:

Supporting Documents for Client Waiver include:

a. Eligibility determination form.

b. Individual Services Plan with MD signature.

c. Two most recent Quarterly Reviews for established client.

d. CANS/ANSA, Biopsychosocial/Functional Assessment, or equivalent, dated in past year.

e. CMHC Case/Care Management Plan or equivalent.

f. Case Management “DUAL CM” waiver - include Area Agency’s ISP and CM plan.

Supporting Documents for Staff Waiver include:

a. Resume of staff employment, education, and relevant experience or signed employment application.

b. For criminal history, the State of NH criminal records & Bureau of Elderly and Adult Services (BEAS) checks completed within 90 days of the waiver request.

Guidelines:

1. Incomplete waivers will not be processed and the agency will receive notification of this. It will be the agency’s responsibility to review the waiver and submit a complete version.

2. Waiver requests that require DHHS legal consultation or review/consultation with another DHHS department may exceed (45) days for approval decision.

3. All requests are initiated by a single point of contact from the CMHC or agency. All follow-up communication will occur between the Bureau and the Agency contact.

4. It is preferred that waiver requests be sent via secure e-mail as a single PDF or Word document attachment with the waiver form first and the supporting documents following.

a. Subject line is: “WAIVER from [agency name] to BMHS on [mmddyy]”.

b. E-mail to BMHS Program Planner: Sandra.Lawrence@dhhs.nh.gov

c. Requests may be faxed to 603-271-5040.

d. Or mailed to:
New Hampshire Department of Health and Human Services
Division for Behavioral Health
Bureau of Mental Health Services
105 Pleasant Street
Concord, New Hampshire 03301

5. Agencies will be formally notified of the waiver decision by letter from BMHS.

6. If you have not heard back with an approval decision from the Bureau within (30) days, please contact the BMHS Administrator of Community Mental Health Services for a status update.

 

Waiver Request Form Adobe Acrobat Reader Symbol

 

Adobe Acrobat Reader Symbol Adobe Acrobat Reader format. You can download a free reader from Adobe.

 

 
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New Hampshire Department of Health and Human Services
129 Pleasant Street | Concord, NH | 03301-3852


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