HB723 (2007) Detail

(New Title) extending the moratoriums on nursing home beds and rehabilitation and relative to long-term care.


CHAPTER 330

HB 723 – FINAL VERSION

05/24/07 1669s

27Jun2007… 2272cofc

2007 SESSION

07-0922

01/03

HOUSE BILL 723

AN ACT extending the moratoriums on nursing home beds and rehabilitation and relative to long-term care.

SPONSORS: Rep. King, Coos 1; Rep. Nordgren, Graf 9

COMMITTEE: Health, Human Services and Elderly Affairs

AMENDED ANALYSIS

This bill:

I. Extends the moratoriums on nursing home beds and rehabilitation until June 30, 2009.

II. Authorizes individuals eligible to receive Medicaid-funded nursing home services with the right to have their individual support plans developed through a person-centered planning process regardless of age, disability, or residential setting.

III. Maintains current eligibility criteria for nursing facility services which would change on July 1, 2007.

IV. Requires that the department calculate accurate cost estimates of the full cost to the state of adequately funding long-term care services and to submit these estimates as an informational addendum with its budget request.

V. Authorizes the department of health and human services to establish a presumptive eligibility process for applicants seeking Medicaid or Medicaid-waiver coverage for long-term care services.

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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

05/24/07 1669s

27Jun2007… 2272cofc

07-0922

01/03

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Seven

AN ACT extending the moratoriums on nursing home beds and rehabilitation and relative to long-term care.

Be it Enacted by the Senate and House of Representatives in General Court convened:

330:1 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.

330:2 Rehabilitation Beds; Moratorium Extended. Amend 2004, 260:27 to read as follows:

260:27 Health Services Planning and Review Board; Rehabilitation Beds and Services. From June 16, 2004 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.

330:3 Applicability. This act shall apply to all certificates of need under sections 1 and 2 of this act except for any application for a certificate of need which was filed with the health services planning and review board on or before June 30, 2007.

330:4 Long-Term Care; Purpose. Amend RSA 151-E:1, III to read as follows:

III. This chapter is [an initial] an essential step toward [incrementally] rebalancing the long-term care system and expanding choices available to recipients. It increases the continuum of care by adding mid-level care, including but not limited to, assisted living and residential care services. Through an acuity-based reimbursement system [and], a comprehensive needs assessment process, and an information and assistance process, it [encourages] provides those eligible for Medicaid nursing facility services the opportunity to [consider] choose more appropriate, less costly mid-level services and home and community-based care. In this way, the state intends to serve this increasing Medicaid eligible population more appropriately and more economically.

330:5 New Paragraph; Long-Term Care; Definition Added. Amend RSA 151-E:2 by inserting after paragraph VII the following new paragraph:

VII-a. “Person-centered planning” means a planning process to develop an individual support plan that is directed by the person, his or her representative, or both, and which identifies his or her preferences, strengths, capacities, needs, and desired outcomes or goals.

330:6 Long-Term Care; Eligibility for Nursing Services. Amend the introductory paragraph of RSA 151-E:3, I(a) to read as follows:

(a) Clinically eligible for nursing facility care because the person requires 24-hour care for one or more of the following purposes, as determined by registered nurses [employed by state or county government using] appropriately trained to use an assessment tool and employed by the department, or a designee acting on behalf of the department:

330:7 New Paragraph; Long-Term Care; Assessment Tool. Amend RSA 151-E:3 by inserting after paragraph III the following new paragraph:

IV. For the purposes of the assessment performed pursuant to paragraph I, the registered nurse shall obtain and give substantial weight to clinical information provided by the applicant’s physician, including, but not limited to, diagnosis, prognosis, and plan of care recommendations.

330:8 Long-Term Care; Consumer Choice. Amend RSA 151-E:4 to read as follows:

151-E:4 Consumer Choice. A person who has been determined to be Medicaid eligible for nursing facility services in accordance with RSA 151-E:3 shall have the right to receive nursing facility services; however, the person shall be offered and may choose to receive services in a less restrictive setting if such services are available and do not result in costs to the state and counties in excess of the limitations set forth in RSA 151-E:11, II. Such choice shall be offered in accordance with state laws and federal regulations. The person shall have the right to have his or her individual support plan developed through a person-centered planning process regardless of age, disability, or residential setting. The department shall take into consideration the family and community supports available to the person, the family’s desire and ability to care for the person, and shall ensure that all consideration and support is offered to the family to maintain the person in home and community-based care. Nothing in this section is intended to require the provision of financial assistance or supports by a family member.

330:9 Long-Term Care; Information and Referral. Amend RSA 151-E:5 to read as follows:

151-E:5 Information and Referral. The department shall establish a system of community-based [focal points] information and referral resource centers that provide information and referral services to elderly and chronically ill adults. The information and referral network established under this section shall not be used for the purpose of political [or legislative] advocacy, but may inform and educate the general court regarding the extent of services available as well as the unmet needs in the community.

330:10 New Sections; Annual Report; Medicaid Waiver Program; Eligibility. Amend RSA 151-E by inserting after section 15 the following new sections:

151-E:16 Accurate Cost Estimates.

I. The department shall estimate and report the full cost to the state of adequately funding long-term care services at a level which ensures all eligible individuals the quality services which they need and for which they are eligible. The cost estimates shall include the cost to fund home and community-based, mid-level, and nursing facility care at a reimbursement level necessary to ensure that individuals who are eligible for Medicaid-funded long-term care services have access to quality services in all 3 settings, are able to live with dignity in a safe environment, and are able to exercise choice in their care setting. The department estimate shall be based on provider reimbursement rates that ensure a provider workforce that is sufficient to fully meet the needs of eligible consumers.

II. The department shall include the estimate required by paragraph I as an informational addendum to its budget submission.

151-E:17 Availability of Targeted Management Services. The department shall make available to and advise all Medicaid recipients who require a nursing facility level of care or are at risk of needing such care and who are patients in hospitals, rehabilitation hospitals, or nursing facilities of the availability of targeted case management services provided by independent case managers, to explore the feasibility of transitioning to home and community-based care.

151-E:18 Presumptive Eligibility.

I. The commissioner of the department shall establish a presumptive eligibility program to prevent unnecessary and costly institutionalization of individuals who are Medicaid eligible for nursing facility services and choose to receive services in less restrictive settings.

II. Pending verification of application information, the department shall authorize medical assistance in the interval between application and the final Medicaid eligibility determination if the department determines the applicant is likely to be eligible. Presumptive eligibility shall be made available at department district offices, information and referral resource centers, and other qualified providers. The presumptive eligibility period shall not include coverage of home or environmental modifications.

III. Presumptive eligibility authorizations shall be dependent upon a face-to-face clinical assessment of each applicant and review of a completed Medicaid application. The department shall perform the face-to-face clinical assessment within 20 business days of a request for medical assistance. The department shall review the application for presumptive eligibility within 5 business days of completion of the Medicaid application and clinical assessment.

IV. The presumptive eligibility period begins on the date the department determines the applicant likely meets the eligibility criteria and ends on the date eligibility is verified or the individual is determined ineligible.

V. The Medicaid applicant shall acknowledge in writing the uncertainty of continuing service coverage beyond the presumptive eligibility period and the potential for financial responsibility for costs incurred in the event of a determination of Medicaid ineligibility.

VI. If an applicant is determined ineligible for Medicaid, the department shall promptly notify the applicant and the applicant’s providers of the finding and the immediate termination of service coverage authorization. In such a case, the department shall use non-Medicaid funds to pay for any waiver services which the applicant has already received. In the event an application was filed with fraudulent intent, the department shall be entitled to reimbursement of funds expended on behalf of the applicant.

VII. The commissioner of the department shall adopt rules, pursuant to RSA 541-A, relative to:

(a) A process to determine presumptive eligibility.

(b) A definition of a qualified provider.

(c) Content and format of forms required under this section.

330:11 Repeal. The following are repealed:

I. 2005, 175:22, relative to eligibility for nursing services.

II. 2005, 175:25, III, relative to a prospective effective date.

330:12 Effective Date.

I. Section 11 of this act shall take effect June 30, 2007.

II. Sections 1-3 of this act shall take effect upon its passage.

III. The remainder of this act shall take effect January 1, 2008.

Approved: July 16, 2007

Effective: I. Section 11 shall take effect June 30, 2007.

II. Sections 1-3 shall take effect July 16, 2007.

III. Remainder shall take effect January 1, 2008.