HB 1730-FN-LOCAL – AS INTRODUCED
2006 SESSION
01/10
HOUSE BILL 1730-FN-LOCAL
AN ACT relative to long-term care program management and cost controls.
SPONSORS: Rep. Kurk, Hills 7; Sen. Johnson, Dist 2
COMMITTEE: Health, Human Services and Elderly Affairs
This bill clarifies nursing home cost controls for the long-term care management program.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
06-2947
01/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Six
AN ACT relative to long-term care program management and cost controls.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Long-term Care Program Management and Cost Controls. Amend RSA 151-E:11 to read as follows:
151-E:11 Program Management and Cost Controls.
I. The department shall designate in its operating budget requests specific class lines for nursing facility, mid-level, and home-based care provided for in this chapter. These class lines shall reflect, and the requesting documentation shall include, the anticipated number of persons to receive services. Notwithstanding any provision of law to the contrary, the department shall not increase expenditures in approved budgets for [these class lines], or the number of persons to receive, mid-level or home care services [without the approval of the legislative fiscal committee, and the prior review of the county-state finance commission], nor shall there be any transfer of funds into such class lines. The medicaid rates paid for nursing facility services, mid-level care services, and home and community-based care services shall not be reduced below those levels in effect on the last day of the previous biennium. No transfers may be made from the nursing facility medicaid quality incentive program and all funding derived from that program shall be paid to nursing facilities.
II. For the fiscal year beginning July 1, 2003, and each fiscal year thereafter the average annual cost for the provision of services to persons in the mid-level of care shall not exceed 60 percent of the average annual cost for the provision of services in a nursing facility. The average annual cost for the provision of services in home-based care shall not exceed 50 percent of the average annual cost for the provision of services to persons in a nursing facility. Average annual costs shall be the net medicaid costs exclusive of provider payments. [No person whose costs would be in excess of 80 percent of the average annual cost for the provision of services to a person in a nursing facility shall be approved for home-based or mid-level services without the prior approval of the commissioner of health and human services.] The department shall provide a report semi-annually on the utilization of non-nursing home services to the county-state finance commission and the legislative fiscal committee.
III. The department shall not increase the so-called budget neutrality factor above the factor which was in effect on the last day of the previous biennium. The department shall increase nursing home rates in accordance with nursing home funding increases in the state operating budget and the projection of the average number of persons to receive services which is included in the state operating budget. When the department performs its semi-annual rate adjustment as required by RSA 151-E:6-c, II, the department shall make rate adjustments which are based on changes in acuity levels, and shall make increases or decreases in payment which are directly related to actual increases or decreases in acuity. In the event that the number of nursing home residents falls below the number established in the state operating budget, up to 50 percent of the savings associated with such volume reduction may, with the approval of the fiscal committee of the general court and the governor and executive council, be transferred out of the nursing home class line. In no event, however, shall the aggregate medicaid reimbursement for nursing facilities through PAU 05-01-08-04-01, class 90, be reduced below the level in effect as of February 1, 2003. In the event of a transfer of up to 50 percent of savings as provided herein, the remaining savings shall be used to reduce or eliminate the so-called budget neutrality factor. In the event that the number of persons receiving nursing home care exceeds the projection in the state operating budget of the average number of persons to receive such services, the department shall transfer sufficient funding to pay for the care of these additional persons.
2 Effective Date. This act shall take effect July 1, 2006.
LBAO
06-2947
Revised 12/21/05
HB 1730 FISCAL NOTE
AN ACT relative to long-term care program management and cost controls.
FISCAL IMPACT:
The Department of Health and Human Services states this bill will increase state revenue and state and county expenditures by indeterminable amounts in FY 2007 and each year thereafter. The New Hampshire Association of Counties states this bill will have an indeterminable impact on county expenditures and revenue. There will be no fiscal impact on local expenditures or revenue.
METHODOLOGY:
The Department of Health and Human Services assumed that limiting the number of eligible home or mid-level care recipients could increase the number of clients moving into more costly nursing home care. On average, the annual cost of nursing home care is $27,100 more than home care and $26,550 more than mid-level care. The Department assumed eliminating the Commissioner’s ability to approve home and community-based services for an individual that exceeds 80% of the average annual nursing facility cost will prevent the Department from using this approval as a cost control measure. The Department is not able to estimate the fiscal impact of these changes.
The New Hampshire Association of Counties assumed the effect of this bill would be to cap funds available for home and community-based care to the amounts appropriated in the operating budget. The counties are responsible for 50% of the non-federal share of these expenditures, therefore this bill would prevent increases in county expenditures for these services. The Association further assumes savings from a reduction in the nursing home population would be used to increase nursing home rates, which would increase revenue to the counties.