(1) Reside with at least one parent;
(2) Be able to receive services in the home as defined in 45 CFR 233.90(c)(1)(v)(B);
(3) Meet the recipient criteria of He-W 641.04, except that, pursuant to the prohibition in 1614(f)(2)(B) of the Social Security Act on the deeming of parental income, the criteria of He-W 641.04(c)-(e) shall not apply;
(4) Have an impairment or combination of impairments that meets, medically equals, or functionally equals the criteria for an impairment listed in 20 CFR Pt. 404, Subpt. P, App.1;
(5) Require the same degree of care that is typically provided in a hospital, nursing facility or intermediate care facility for the mentally retarded as specified at He-W 508.03, in accordance with Section 1902 (e) (3) of the Social Security Act; and
(6) Require a written opinion from a treating physician that home care is medically appropriate and safe.

(1) The care can be provided in the child's home without jeopardizing the medical needs of the child;
(2) Primary caregivers who reside with the child have expressed a willingness and desire to assume health care responsibility for the child in order to maintain the child at home; and
(3) Primary caregivers who reside with the child have been trained to support the child's needs in the home.

(1) The child would reside in the hospital, or require frequent hospitalizations if services were not provided;
(2) The child's condition, which requires hospital level of care, is expected to last for at least one year from the date of application;
(3) The child requires an extensive array of health care services throughout the day including:

a. Hands on comprehensive medical interventions and treatments;
b. Direct medical monitoring and assessment; and
c. Intense medication regimen for the child's medical condition;

(4) The child requires complex daily skilled medical treatment that is more complex than a nursing facility level of care, involving all of the following:

a. Specialized training to perform the treatment safely and effectively;
b. The ability to recognize changes in the child's condition that require prompt interventions to avert complications; and
c. The ability to modify treatment plans throughout the day based on the child's condition;

(5) The child requires daily use of sophisticated medical equipment such as ventilators and central venous lines which require frequent monitoring; and
(6) The seriousness of the child's medical condition creates a constant potential for aspiration, respiratory obstruction, or cardiac or respiratory arrest requiring the need for prompt, recurrent, skilled interventions to sustain life.

(1) The child has a serious emotional disturbance as defined in 42CFR483.102(b)(1) that is expected to last for at least one year from the date of application; and
(2) The intensity of the child's mental health needs are so severe that without proper interventions in the home and community, the child would reside in a hospital or require frequent hospitalization;
(3) The child has severe limitations in at least three (3) of the following capacities:

a. A consistent inability to take care of age appropriate personal self care such as grooming, hygiene, dressing, toileting, and eating;
b. Functioning in the community such as constant lack of judgment, behavioral control, or decision-making skills resulting in imminent involvement with the juvenile justice system;
c. Functioning in social relationships such as persistent inability to maintain relationships with peers and adults;
d. Functioning in the family such as repeated unprovoked violence toward family members, chronic destructive patterns, and an inability to conform to basic limits; or
e. Functioning at school or work such as persistent failing grades, repeated truancy, expulsion, and inability to meet educational goals;

(4) The child has severely disabling symptoms for which office centered outpatient treatment is not adequate;
(5) The child has an impairment requiring 24 hour monitoring or supervision;
(6) The child is receiving mental health counseling services of 3 hours or more per week for a period of at least 3 months through either mental health, special ed related to emotional needs, juvenile justice, child protective services, or social services; and
(7) Children under the age of four years shall be determined in accordance with He-W 508.03(a) or He-W 508.03(c) due to the intensity and nature of their needs.

(1) The child requires nursing facility level of care that is expected to last at least 1 year from the date of application;
(2) The child would reside in a nursing facility if the following services were not provided on a daily basis:

a. Complex and comprehensive hands on nursing care as described in He-W508.03 (a)(3); or
b. Complex and comprehensive rehabilitative care which shall include at least 3 hours of therapy; and
c. Direct hands on assistance to perform complex nursing treatments or all activities of daily living; and
d. Hands on care which substantially exceeds age appropriate assistance.

(3) Complex skilled nursing care or comprehensive rehabilitative interventions are necessary, including all of the following:

a. Modifications in the child's plan of treatment are necessary throughout the day;
b. There is a high probability for complications, unusual outcomes, and adverse reactions due to the complexity and intensity of the child's impairment;
c. Specialized professional training and monitoring beyond those ordinarily expected of parents are needed to assist parents in acquiring skills and judgment to safely provide home care;
d. The child's impairment substantially interferes with the ability to engage in everyday activities and perform age appropriate activities of daily living at home and in the community including, but not limited to bathing, dressing, toileting, feeding, and walking/mobility; and
e. The child's daily routine is substantially altered by the need to complete these specialized, complex, and time consuming treatments or need for assistance with self care activities.

(1) The child has a developmental disability as defined in RSA 171 A:2,V that is expected to last for at least one year from the date of application;
(2) The child requires a continuous and pervasive active treatment program throughout the child's daily routine;
(3) The child's developmental disability requires a 24 hour plan of care including supervision and active treatment for medical, behavioral, or habilitation needs;
(4) The child's developmental disability results in substantial impairments of general intellectual functioning and adaptive behavior requiring continuous supervision, monitoring, and redirection of behaviors to a substantially greater degree than other children in the child's particular age group.
(5) The child's developmental disability results in functional limitations to a substantially greater degree than other children in the child's particular age group in at least three (3) of the following major life activities:

a. Self-care and Capacity for Independent Living. The child is unable to perform major activities of daily living independently, or requires extraordinary assistance from other persons;
b. Mobility. The child is non-ambulatory and dependent on others for moving skills or needs substantial assistance to move about;
c. Understanding and use of language. The child has no expressive or receptive communication skills or needs substantial assistance to communicate;
d. Learning. The child scores four (2) or more deviations below the norm on current accredited standardized cognitive tests; and
e. Self-direction. The child demonstrates a lack of internal control and direction exemplified by exhibition of any of the following behaviors on at least a monthly basis of an intensity that requires a professional behavioral treatment plan:

1) Physical or verbal aggression;
2) Temper tantrums;
3) Self-injurious behavior;
4) Inappropriate handling of body wastes;
5) Ingestion of non-food substances; or
6) Ritualistic or persevering behaviors which interfere with social relationships; and

(6) Eligibility for children under the age of 5 years shall be determined in accordance with He-W 508.03(a) or He-W 508.03(c) due to the intensity and nature of their needs.

(1) The MRT determines that the recipient does not meet the eligibility criteria specified in He-W508.02; and
(2) The recipient fails to submit a continuation of benefits request to the local district office within 10 days from the date of written notice of adverse decision.

(1) The recipient's identifying information;
(2) A listing of the medical and non-medical reports considered during the determination process;
(3) A description of the impairments considered during the determination process;
(4) The reasons for the department's action;
(5) Citations from federal and state statutes and regulations supporting the department's actions; and
(6) An explanation of the individual's right to appeal the department's determination and to reapply for medical assistance.