Below is a glossary of terms used in New Hampshire:
Consultation – The rendering, by a licensed practitioner of the healing arts, of an expert opinion regarding the diagnosis or treatment of a specific child pursuant to He-M 1301.04.
Group – A group is defined in policy as the number of students receiving covered services simultaneously, regardless of the students’ Medicaid eligibility. For example, when a Speech therapist is delivering speech therapy to four students at the same time, but only one of them is Medicaid eligible, the group size is four, not one. MSB™ suggests that you do NOT include as part of the group size the students that are included in the group for “modeling” or to enhance the group dynamic, but are not receiving services. MSB suggests that you DO include as part of the group size the students that are part of the group and are receiving covered services due to an education plan (i.e. IEP, 504 or RTI).
Licensed Practitioner of the Healing Arts (LPHA) – Any person licensed or certified under state law to provide a medical, psychological, or other service, the goal of which is improvement or maintenance of a person’s physical or emotional functioning.
Order – A physician or licensed practitioner of the healing arts written authorization or prescription for the provision of services. MSB strongly encourages the use of its Order/Recommendation/Referral Form (ORRF) for purposes of documenting a Physician’s Order or the order from a LPHA.
Professional Oversight – A feature in Lumea™ used where a Service Provider requires a secondary signature on her service records. This feature will route the provider’s submitted sessions to the appropriate Team Leader (see below). This feature is automatic and is utilized for either a Rehabilitative Assistant that requires weekly consultation and attestation of health-related services by an LPHA, or for those cases where an assistant is under the direction of a professional who is co-signing the forms for the assistant.
Referral – A physician or licensed practitioner of the healing arts’ written recommendation that services of a specific nature should be provided. MSB strongly encourages the use of its Order/Recommendation/Referral Form (ORRF) for purposes of documenting a Physician’s recommendation or the recommendation from a LPHA.
Team Leader – A role in Lumea, assigned to LPHAs, that allows them to electronically document that a weekly consultation has taken place and attest to the health-related nature of Rehabilitative Assistance services as required under the Medicaid to Schools regulations. The Team Leader role in Lumea must also be utilized for someone that is directing an assistant and co-signing service records (i.e. SLP supervisor would co-sign the logs for a Speech Language Assistant). The Medicaid regulations now require a co-signature for service providers documenting services under the direction of a LPHA due to regulation changes that were finalized during the summer of 2016.
Transaction Log – Documentation of services, including the following:
- The name of the child
- The name of the person providing each covered service
- The handwritten signature (in original ink) of the person providing each covered service
- The type of service provided
- The date(s) of service delivery
- The duration of the service provided (number of units)
- The group size
- For Rehabilitative Assistance, the LPHA certification statement and handwritten signature of the LPHA
- For assistants providing OT, PT or Speech, the signature of the qualified practitioner providing direction.
Unit – 15 minute or 30-minute duration of service delivery, depending upon HIPAA standard procedure codes. CMS guidelines indicate that in order for a unit to be counted, the time spent on the service must meet a minimum threshold of 50% of the designated unit length. For example, in order to submit a claim for a 30-minute unit, at least 15 minutes of service must have taken place. For a 15-minute unit type, at least 8 minutes of service must have taken place. The same process follows for subsequent units. For example, in order to bill a second unit for a 30-minute unit type, at least 45 minutes would need to elapse. For a 15-minute unit, at least 23 minutes would need to elapse.
Waiver – A mechanism whereby providers may request an alternative to specific procedures outlined in He-M 1301. The request must be in writing and submitted to the Department of Health and Human Services, Office of Client and Legal Services and shall include specific reference to the section of the rule for which a waiver is being sought, a full explanation of why a waiver is necessary, and a full explanation of alternative procedures proposed by the provider. Waivers should also request LPHA status so that the practitioner may also provide consultation and attestation of the health-related nature of Rehabilitative Assistance as required on Rehabilitative Assistance logs. It has been determined at the state level that providers holding BCBA credentialing will not be permitted to act as the LPHA for Rehabilitative Assistance services even though a waiver for mental health services may be approved. Waivers are not retroactive, so filing waivers in a timely fashion is crucial to optimizing Medicaid reimbursement.
 He-M 1301.02 (b)
 He-M 1301.02 (h)
 He-M 1301.02 (k)
 He-M 1301.02 (n)
 He-M 1301.06