HB 638-FN – AS AMENDED BY THE SENATE
18Jan2006… 0250h
05/04/06 2135s
2005 SESSION
10/01
HOUSE BILL 638-FN
AN ACT relative to county liability for payment of nursing home facility costs, long term care financing, and relative to the county-state finance commission.
SPONSORS: Rep. King, Coos 1; Sen. Odell, Dist 8
This bill:
I. Establishes the liability of counties for nursing home costs and long term care costs.
II. Removes the increase in county payments for old age assistance and aid to the permanently and totally disabled.
III. Extends the moratoriums on nursing home and rehabilitation beds.
IV. Renames the county-state finance commission as the long term care commission, increases its membership, and changes the duties of the commission.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
18Jan2006… 0250h
05/04/06 2135s
05-0469
10/01
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Five
AN ACT relative to county liability for payment of nursing home facility costs, long term care financing, and relative to the county-state finance commission.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Certificate of Need; Nursing Home Beds; Moratorium Extended. Amend RSA 151-C:4, III(a) to read as follows:
III.(a) No certificate of need shall be granted by the board for any nursing home, skilled nursing facility, intermediate care facility or rehabilitation facility from the effective date of chapter 310, laws of 1995, department of health and human services reorganization act, through the period ending [December 31, 2006] June 30, 2009, except that a certificate of need shall be issued for replacement or renovation of existing beds as necessary to meet life safety code requirements or to remedy deficiencies noted in a licensing inspection pursuant to RSA 151 or state survey and certification process pursuant to titles XVIII and XIX of the Social Security Act.
2 Rehabilitation Beds. Amend 2004, 260:27 to read as follows:
260:27 Health Services Planning and Review Board; Rehabilitation Beds and Services. Through the period ending [December 31, 2006] June 30, 2009 unless sooner authorized by the general court, the health services planning and review board shall not authorize changes regarding the licensure or certification of any rehabilitation beds in any type of facility, shall not authorize the addition of any rehabilitation beds in any type of facility, and shall not grant any certificate of need related to the board’s administrative standards for comprehensive physical rehabilitation services. This section shall not prohibit the voluntary transfer of rehabilitation beds between 2 licensed health care facilities; provided, that any such transaction does not result in an increase in the number of any type of rehabilitation beds in the state.
3 Reference Changed. Amend RSA 151-E:6-b to read as follows:
151-E:6-b Memorandum of Agreement. The department of health and human services shall establish, by means of a memorandum of agreement with the New Hampshire Association of Counties, a mechanism for the receipt of input from the Association of Counties regarding the type, cost, utilization, and procedures relative to payments which the counties are obligated to make pursuant to RSA [167:18-b] 167:18-a. The memorandum of agreement shall be reviewed annually and amended as may be determined to be necessary by the parties.
4 Reference Changed. Amend RSA 151-E:15, IV to read as follows:
IV. Notwithstanding the provisions of RSA [167:18-b, I] 167:18-a, no county shall be required to make any contribution to the distribution under this section.
5 County Reimbursements; Limitation on Payments. RSA 167:18-a is repealed and reenacted to read as follows:
167:18-a County Reimbursement of Funds; Limitations on Payments.
I. All expenditures in carrying out the purposes of this chapter and RSA 161 relative to recipients of old age assistance and aid to the permanently and totally disabled shall in the first instance be made by the state, but each county shall make monthly payments to the state for the amounts due under this section within 45 days from notice thereof.
(a) Counties shall reimburse the state for expenditures for recipients of old age assistance or aid to the permanently and totally disabled for whom such county is liable to the extent of 50 percent of state supplemental financial assistance.
(b) Counties shall reimburse the state for expenditures for recipients for whom such county is liable who are eligible for nursing home care and are receiving services from a New Hampshire licensed nursing home, or in another New Hampshire setting as an alternative to a nursing home placement and are supported under the Medicaid home and community-based care waiver for the elderly and chronically ill, as such waiver may be amended from time to time, to the extent of 60 percent of the non-federal share of such expenditures.
(c) Counties shall not be liable for Medicaid recipients in state institutions and intermediate care facilities for the mentally retarded (ICF-MR) approved by the department of health and human services and servicing developmentally impaired persons.
II. The total reimbursements by all counties made pursuant to this section and RSA 167:18-f shall not exceed the amounts set forth below for the state fiscal years 2007-2009:
(a) State fiscal year 2007 $78,000,000.
(b) State fiscal year 2008 $81,000,000.
(c) State fiscal year 2009 $84,000,000.
III.(a) Any shortfall between the state audited Medicaid allowances incurred by the state’s county operated ICF nursing homes and amounts otherwise reimbursed by federal 50 percent Medicaid matching funds or other income, shall be certified as a public expenditure and be eligible for additional federal funding match.
(b) The department of health and human services shall seek federal Medicaid assistance match for any state audited county nursing home Medicaid expense which is not fully reimbursed through rates. Any revenue realized through such a match shall be paid to the nursing homes which incurred the unreimbursed expense, provided, however, that no state general funds are expended directly or indirectly for this purpose.
6 Delinquent Payments. Amend RSA 167:18-e to read as follows:
167:18-e Delinquent Payments. Delinquent payments due under RSA 167:18-a[, 167:18-b] and 167:18-f, with interest at the rate of 12 per centum per annum, may be recovered by action in a court of competent jurisdiction against the political subdivision liable therefor or may, at the request of the state agency, be deducted from any other moneys payable to such subdivision by any department or agency of the state.
7 County Nursing Homes; Local Medical Assistance Contribution. Amend RSA 167:18-f to read as follows:
167:18-f Local Medical Assistance Contribution. In addition to any other reimbursement required by law, each county shall, within 60 days from notice thereof, reimburse the public assistance fund at the rate of [$27] $6 per month for each recipient of old age assistance and [$52]$23 per month for each recipient of aid to the permanently and totally disabled for whom the county would be liable under the provisions of RSA 166, except that no reimbursement shall be required for any recipient for whom the county has an obligation under RSA [167:18-b] 167:18-a.
8 Appropriation; Health and Human Services. The sum of $4,650,061 is hereby appropriated to the department of health and human services for the biennium ending June 30, 2007 for the purposes of this act. The governor is authorized to draw a warrant for said sum out of any money in the treasury not otherwise appropriated.
9 County Credit for Contributions. Any county reimbursement under RSA 167:18-f made from July 1, 2005 until June 30, 2006 which exceeds the rate for reimbursement provided in section 7 of this act shall be credited to the counties for the year ending June 30, 2006 for fulfilling the local medical assistance contribution.
10 Medical Parole. Amend RSA 651-A:10-a, VII to read as follows:
VII. Notwithstanding RSA [167:18-b] 167:18-a, the state shall be responsible for all medicaid costs incurred, net of federal reimbursement, for any inmate granted medical parole under this section, until the earliest date on which parole could have been granted had the inmate not been granted medical parole.
11 County-State Long Term Care Commission. Amend RSA 28-B to read as follows:
CHAPTER 28-B
COUNTY-STATE [FINANCE] LONG TERM CARE COMMISSION
28-B:1 Commission Established. There is hereby established the county-state [finance] long term care commission which shall consist of the following members:
I. The commissioner of the department of health and human services.
II. The director of the division of elderly and adult services in the department of health and human services.
III. [Three] Two members appointed by the commissioner of the department of health and human services, and one member appointed by the governor and council, who shall serve 2-year terms, provided that the initial terms of 2 such members shall be for one year.
IV. [Six] Four members representing county government, [all] appointed by the commissioner’s council of the New Hampshire Association of Counties, who shall serve 2-year terms, [provided that the initial terms of 3 such members shall be for one year.] 2 of whom shall represent counties with population of more than 100,000 and 2 of whom shall represent counties with population of less than 100,000.
V. Four members of the general court, with 2 house of representatives members, one of whom shall be a member of the house finance committee appointed by the speaker of the house of representatives, and 2 senate members, one of whom shall be a member of the senate finance committee, appointed by the president of the senate. General court members shall serve for their elected term of office.
28-B:2 Chairperson; Meetings. The commission shall elect a chairperson from among its members, provided that the chair shall alternate between a state and a county representative in a manner determined by the commission. The commission shall meet at least quarterly and shall adopt rules for its procedures. The department of health and human services shall provide staff assistance in support of the commission.
28-B:3 Duties of the Commission. The county-state [finance] long term care commission shall oversee the financial relationship and the development of policy associated with programs for which the county and state governments share funding obligations. The commission shall have the following responsibilities:
I. Review and [provide recommendations about] approve the state’s long-term care medicaid plan under RSA 151-E and related provisions which address programs for which counties have financial obligation prior to submission of such plans to the federal medicaid agency.
II. Review and provide recommendations regarding department of health and human services rate setting and adjustments [including, but not limited to, those for] related to long-term care services for elderly and adult clients by the division of elderly and adult services, court-ordered and volunteer services by the division for children, youth, and families, and the division of juvenile justice services, prior to any rate setting or adjustments.
III. Review and provide recommendations for refinement of county billing systems for all payments from the counties to the state.
IV. Pursue and evaluate funding options.
[V. Develop a process for managing individual county payment limits under RSA 167:18-b, IV. In no event shall the individual county payment limit reduce or alter the total county obligation under RSA 167:18-b, IV.]
12 Long-Term Care; Program Management. 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. 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 final approval of the legislative fiscal committee, and the prior [review] approval of the county-state [finance] long term care commission. 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] long term care commission and the legislative fiscal committee.
13 Rulemaking; Public Assistance; County-State Long-Term Care Commission. Amend RSA 167:3-c, XIII to read as follows:
XIII. The administration of the payment of funds for persons eligible to receive nursing home services. Prior to the submission of proposed rules under RSA 541-A, such rules shall be submitted for review by the county-state [finance] long term care commission under RSA 28-B.
14 Repeal. The following are repealed:
I. RSA 167:18-b, relative to county reimbursement for nursing home services.
II. RSA 167:20, relative to establishing the public assistance fund.
III. 1998, 388:16, I and II, relative to the repeal of RSA 167:18-b and 18-f.
IV. 1998, 388:17, II, as amended by 2003, 223:8, 2004, 260:9, and 2005, 177:10 relative to the effective date of the repeal of RSA 167:18-b and 18-f.
15 Prospective Repeal; July 1, 2009. RSA 167:18-a, relative to county reimbursement of funds, is repealed.
16 Effective Date.
I. Section 7 of this act shall take effect July 1, 2005 at 12:01 a.m.
II. Sections 8 and 9 of this act shall take effect June 30, 2006.
III. Section 15 of this act shall take effect July 1, 2009.
IV. The remainder of this act shall take effect July 1, 2006.
LBAO
05-0469
Amended 2/23/06
HB 638 FISCAL NOTE
AN ACT relative to county and state financing of nursing home services.
FISCAL IMPACT:
The Department of Health and Human Services and Association of Counties states this bill, as amended by the House (Amendment #2006-0250h), will increase state expenditures and decrease county expenditures by an indeterminable amount in FY 2006 and FY 2007. This bill will have no fiscal impact on state, county, and local revenue or local expenditures.
This bill appropriates $5,400,000 to the Department of Health and Human Services from the state general fund for the biennium ending June 30, 2007 for the purposes of this act.
METHODOLOGY:
The Department of Health and Human Services (DHHS) states this bill extends the current moratorium on nursing home and rehabilitation beds through June 30, 2009. The extension of the moratorium will have no fiscal impact on the Department’s current budget. The Department states without the moratorium Medicaid enrollment could increase by an indeterminable amount, and construction costs for new beds would total approximately $9,968,000 through FY 2010, of which the state and county share would be $2,492,000 each. The Department states section 3 of this bill seeks additional federal reimbursement for county expenditures. The Department estimates no fiscal impact as a result of this section as the combination of Medicaid nursing home rates, supplemental rates paid through the Medicaid Quality Incentive Program, and Proshare currently reimburse facilities at the Medicare Upper Payment Limit, which is the ceiling for allowable federal reimbursement through the Medicaid Program.
The Department states sections 4 to 6 would lower the local medical assistance contribution required to be paid by counties. The Department assumes that the number of recipients for local medical assistance will remain as specified in the FY 2006 and FY 2007 state operating budget. The estimated county expenditure for local medical assistance in the state operating budget was $4,450,678 in FY 2006 and $4,501,323 in FY 2007. This bill would reduce these county expenditures to $1,762,565 in FY 2006 and $1,793,236 in FY 2007. This represents a decrease in county expenditures of $2,688,113 in FY 2006 and $2,708,087 in FY 2007, or $5,396,200 over the biennium. State general fund expenditures would increase by a corresponding amount.
The Association of Counties states this bill would lower the medical surcharge rates required to be paid by the counties for each recipient of old age assistance and aid to the permanently and totally disabled. This bill would provide for a credit for increased payments already made in FY 2006, and would result in lower payment by the counties in FY 2007. Based on the actual recipient counts for the first six months of this year and assuming there will be an increase in clients in FY 2007, the Association estimates there will be a credit back to the counties of $2.35 million as a result of billing in FY 2006, and an estimated savings to the counties of $2.4 million in FY 2007.