RFA-2027-DLTSS-03-MFPTC: Money Follows the Person Transitional Case Management

New Hampshire Department of Health and Human Services
Money Follows the Person Transitional Case Management
Appendix A-1 - Medicaid Billable Supplemental Services
Medicaid Billable Supplemental Services
1. The Medicaid Billable Supplemental Services described in this Appendix A-1 shall be
billed to Medicaid as described herein, and shall not be billed to the overall price
limitation of the Agreement.
2. Pre-Transition Services
2.1. The Contractor must fund transportation that has been arranged by Housing
Navigators for home visits that allow participants to view available housing
options in the community prior to transition and submit claims for reimbursement
as outlined in 1.6 below. Funding for this activity shall not exceed $300 per
person.
2.2. The Contractor must fund housing application and related fees including
criminal background checks, credit checks and vital record request fees prior to
transition and submit claims for reimbursement as outlined in 1.6 below.
Funding for this activity shall not exceed $1,300 per person.
2.3. The Contractor must submit estimates and other supporting documentation as
needed to the Department for pre-authorization approval, for the following
services prior to the commencement of providing:
2.3.1. Home accessibility modifications not to exceed $20,000 per person;
2.3.2. Home cleaning and/or pest eradication not to exceed $2,000 per
person;
2.3.3. Security deposits not to exceed $2,000 per person; and
2.3.4. Utility deposits not to exceed $1,000 per person.
2.4. The Contractor must fund, coordinate and monitor completion of the following
services and submit claims for reimbursement as outlined in section 1.6..
Funding for each service listed below shall not exceed funding caps as outlined
in Section 1.3.
2.4.1. Home accessibility modifications, which must include:
2.4.1.1. Coordinating home modification assessment with approved
provider;
2.4.1.2. Coordinating and scheduling home modification; and
2.4.1.3. Monitoring for completion.
2.4.2. Home cleaning and/or pest eradication which may include:
2.4.2.1. Scheduling home cleaning, including mold remediation, pest
eradication, and other services to ensure home environment
is healthy.
2.4.3. The Contractor must fund and submit claims for reimbursement as
outlined in 1.6 below for securing items needed to establish a
RFA-2027-DLTSS-03-MFPTC Contractor Initials __________
v. 1.0 Page 1 of 2 Date __________

New Hampshire Department of Health and Human Services
Money Follows the Person Transitional Case Management
Appendix A-1 - Medicaid Billable Supplemental Services
household. Funding for this service shall not exceed $5,000 per
person. This activity includes:
2.4.3.1. Facilitating a meeting to identify participant's preferences, and
document within the person-centered plan.
2.4.3.2. Shopping for and securing all items necessary to establish a
household, such as cleaning and cooking supplies, home
furniture, and other items utilizing an approved purchase list
provided by the Department. Any exceptions to the list must
be approved by the Department prior to purchase.
2.5. The Contractor must coordinate all furniture and equipment delivery and set up.
2.6. The Contractor must submit corresponding receipts for all service authorizations
listed in 1.7 and 2.1 through the Contractors New Hampshire Easy account.
2.7. The Contractor must submit claims through MMIS, to the Department for
reimbursement a minimum of fifteen (15) days prior to the participant's transition
into the community, unless otherwise authorized by the MFP Program
Administrator for the following pre-transition expenses:
2.7.1. Transportation to view community housing options;
2.7.2. Housing application and related fees including criminal background
checks, credit checks and vital record request fees;
2.7.3. Home accessibility modifications;
2.7.4. Home cleaning and/or pest eradication;
2.7.5. Security deposits;
2.7.6. Utility deposits; and
2.7.7. Items needed to establish a household.
3. Post-Transition Services
3.1. The Contractor must arrange for, purchase and submit a claim for
reimbursement to the Department for pantry and kitchen stocking items
purchased within the first thirty (30) days of the participant's community
transition. Funding shall not exceed $400 per person.
3.2. The Contractor must bill Medicaid for case management services starting with
month four (4) through month twelve (12) of community tenure, if applicable
utilizing the currently available monthly CFI Case Management reimbursement
rate.
RFA-2027-DLTSS-03-MFPTC Contractor Initials __________
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