§ 167:3-g — Degree of Care

I. In this section, "degree of care" means the level of intensity or extent of medical care, treatment, or intervention required by the child as determined by the medical setting in which the child is being evaluated.
II. In order to determine the most appropriate degree of care under which to evaluate the child, the joint medical review team shall review:
(a) The child's medical condition.
(b) The child's community care needs.
III. The joint medical review team shall determine that the degree of care provided by a hospital is appropriate for the child if the following criteria are met:
(a) The child requires hospitalization for an indefinite period of time; and
(b) Either of the following are met:
(1) The child requires a complex care schedule and the use of sophisticated equipment designed to alert caregivers to potential life-threatening problems; or
(2) The child has the constant potential for aspiration, respiratory obstruction or arrest, and/or other life threatening complications requiring the need for prompt, recurrent, skilled interventions to sustain life.
IV. The joint medical review team shall determine that the degree of care provided by a psychiatric hospital is appropriate for the child if all of the following criteria are met:
(a) The child meets the definition of a child with a serious emotional disturbance established by Department of Health and Human Services Notice, dated May 20, 1993, 58 Federal Register 29422 (1993).
(b) The child has specific symptoms and functional impairments that require professional and community interventions.
(c) The child has problems of a chronic and severe nature requiring an intensive amount of professional supervision which are determined by an inability to function in each of the following major life areas:
(1) Family relations.
(2) Interpersonal and/or social skills.
(3) Educational and/or vocational skills.
V. The joint medical review team shall determine that the degree of care provided by a nursing facility is appropriate for the child if any one of the following criteria are met:
(a) The child is dependent on technologically sophisticated medical equipment such as, but not limited to, ventilators, gastrostomy tubes, or central venous lines to sustain life.
(b) The child requires observations or judgments more than once per hour throughout a 24-hour period or continuously, to maintain health status.
(c) The child requires direct interventions from skilled nursing or skilled rehabilitative professionals to maintain health status.
(d) The child is dependent daily on less sophisticated medical equipment such as, but not limited to, catheters, nebulizers, or oxygen to sustain life.
(e) The child requires observations and judgments less often than once per hour and not less often than once every 3 hours throughout the 24-hour period to maintain health status.
(f) The child requires basic nursing and rehabilitative interventions under the direction and supervision of skilled nursing or skilled rehabilitative professionals.
VI. The joint medical review team shall determine that the degree of care provided by an intermediate care facility is appropriate for the child if each of the following criteria are met:
(a) The child has a developmental disability as defined in RSA 171-A:2, V.
(b) The child requires a continuous and pervasive active treatment program throughout the child's daily routine.
(c) There is a need for the continuity of treatment to and from all home and community-based settings.
(d) Either of the following are met:
(1) The child requires continuous medical monitoring for a chronic severe health problem; or
(2) The child requires continuous supervision, monitoring, and redirection of behaviors associated with any condition, related to an intellectual disability, that results in impairment of general intellectual functioning or adaptive behavior.

Legislative History

2005, 181:2. 2008, 52:6, 7, eff. July 11, 2008.