HB 1612-FN-LOCAL – AS INTRODUCED
2008 SESSION
10/04
HOUSE BILL 1612-FN-LOCAL
AN ACT relative to county and state obligations for costs for nursing care and services, and for court orders for children services.
SPONSORS: Rep. Osborne, Merr 12; Rep. Bouchard, Merr 11; Rep. Tholl, Coos 2; Rep. Weed, Ches 3; Rep. Phinizy, Sull 5
This bill makes changes to the obligations for payments by the state and the counties for costs of nursing care, home and community-based care, old age assistance and aid to the permanently and totally disabled, and court orders for delinquency, abuse and neglect, and children in need of 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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
08-2241
10/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Eight
AN ACT relative to county and state obligations for costs for nursing care and services, and for court orders for children services.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Nursing Care Costs; State and County Obligations. RSA 167:18-a is repealed and reenacted to read as follows:
167:18-a State and County Payment Obligations.
I. The following expenditures in carrying out the purposes of this chapter or RSA 161 shall be made by the state:
(a) Cost of persons eligible for nursing home care who are receiving services from a licensed nursing home, or in another New Hampshire setting as an alternative to a licensed 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.
(b) Payments made for skilled care.
(c) Cost of Medicaid recipients in state institutions, the Crotched Mountain Rehabilitation Center, 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 expenditures in carrying out the purposes of this chapter or RSA 161 relative to old age assistance or aid to the permanently and totally disabled, shall be made in the first instance by the state, provided that each county shall make monthly payments to the state for the amounts due under this paragraph within 45 days from notice thereof and shall reimburse the state for all assistance granted to persons for which such county is liable, to the extent of 100 percent thereof.
2 Delinquent Children; County Share. Amend RSA 169-B:40, IV and V to read as follows:
IV. Notwithstanding paragraph I, the county in which the court is located which issued the order creating liability for expenses for the child shall be responsible for reimbursing the state for up to [25] 75 percent of the costs incurred under this chapter. If the court’s jurisdiction crosses county lines, then the county from which the child was referred to the court shall be responsible for such reimbursement. When determining the amount of reimbursement, all services for which the county would be liable if it were the legally liable unit shall be included, except services which are already the responsibility of the appropriate school district under RSA 186-C.
V. The county which is responsible for reimbursing the state under paragraph IV is authorized to collect, on behalf of the department, payments from persons or entities which are ordered to reimburse the department under paragraph I, or which are chargeable by law for the minor’s support and necessities. Any amounts collected by the county pursuant to this paragraph shall be forwarded to the department, which, in turn, shall apply [25] 75 percent of the amounts collected to reduce the county’s liability under paragraph IV. The county may deduct reasonable administrative expenses directly associated with collections under this paragraph, subject to the approval of the commissioner of the department of health and human services. The commissioner may adopt rules, pursuant to RSA 541-A, relative to this paragraph.
3 Abuse and Neglect Orders; County Share. Amend RSA 169-C:27, IV and V to read as follows:
IV. Notwithstanding paragraph I, the county in which the court is located which issued the order creating liability for expenses for the child shall be responsible for reimbursing the state for up to [25] 75 percent of the costs incurred under this chapter. If the court’s jurisdiction crosses county lines, then the county from which the child was referred to the court shall be responsible for such reimbursement. When determining the amount of reimbursement, all services for which the county would be liable if it were the legally liable unit shall be included, except services which are already the responsibility of the appropriate school district under RSA 186-C.
V. The county which is responsible for reimbursing the state under paragraph IV is authorized to collect, on behalf of the department, payments from persons or entities which are ordered to reimburse the department under paragraph I, or which are chargeable by law for the child’s support and necessities. Any amounts collected by the county pursuant to this paragraph shall be forwarded to the department, which, in turn, shall apply [25] 75 percent of the amounts collected to reduce the county’s liability under paragraph IV. The county may deduct reasonable administrative expenses directly associated with collections under this paragraph, subject to the approval of the commissioner of the department of health and human services. The commissioner may adopt rules, pursuant to RSA 541-A, relative to this paragraph.
4 Children in Need of Services Orders; County Share. Amend RSA 169-D:29, IV and V to read as follows:
IV. Notwithstanding paragraph I, the county in which the court is located which issued the order creating liability for expenses for the child shall be responsible for reimbursing the state for up to [25] 75 percent of the costs incurred under this chapter. If the court’s jurisdiction crosses county lines, then the county from which the child was referred to the court shall be responsible for such reimbursement. When determining the amount of reimbursement, all services for which the county would be liable if it were the legally liable unit shall be included, except services which are already the responsibility of the appropriate school district under RSA 186-C.
V. The county which is responsible for reimbursing the state under paragraph IV is authorized to collect, on behalf of the department, payments from persons or entities which are ordered to reimburse the department under paragraph I, or which are chargeable by law for the child’s support and necessities. Any amounts collected by the county pursuant to this paragraph shall be forwarded to the department, which, in turn, shall apply [25] 75 percent of the amounts collected to reduce the county’s liability under paragraph IV. The county may deduct reasonable administrative expenses directly associated with collections under this paragraph, subject to the approval of the commissioner of the department of health and human services. The commissioner may adopt rules, pursuant to RSA 541-A, relative to this paragraph.
5 Repeal. The following are repealed:
I. 2007, 263:20-22, relative to amendments to county liability for orders for delinquency, abuse and neglect, and children in need of services.
II. 2007, 263:26, relative to the prospective repeal of RSA 167:18-a.
6 Effective Date.
I. Section 5 of this act shall take effect June 30, 2008.
II. The remainder of this act shall take effect July 1, 2008 at 12:01 am.
LBAO
08-2241
12/20/07
HB 1612-FN-LOCAL - FISCAL NOTE
AN ACT relative to county and state obligations for costs for nursing care and services, and for court orders for children services.
FISCAL IMPACT:
The Department of Health and Human Services and Association of Counties state this bill will increase state expenditures and decrease county expenditures by an indeterminable amount in FY 2009 and each year thereafter. This bill will have no fiscal impact on state, county, and local revenue, or local expenditures.
METHODOLOGY:
The Department of Health and Human Services states this bill makes changes to the obligations for payments by the state and the counties for costs of nursing care, home and community base care (HCBC), old age assistance (OAA), aid to the permanently and totally disabled (APTD), and court orders for delinquency, abuse and neglect, and children in need of services (CHINS). The Department’s Division of Family Assistance (DFA) states that in FY 2008 OAA and APTD grants are split 50/50 between the state general fund and the legally liable county, and in FY 2009 are to be funded 100% from the state general fund. This bill would shift 100% of the cost of these grants to the legally liable county beginning in FY 2009. Assuming an 8% annual increase in OAA/APTD payments, DFA estimates this bill will decrease state expenditures and increase county expenditures by $17,791,200 in FY 2009, $19,240,502 in FY 2010, $20,815,752 in FY 2011, and by $22,528,523 in FY 2012.
The Department’s Bureau of Elderly and Adult Services (BEAS) states that while section 1 of the bill only specifically references the BEAS areas of nursing homes, HCBC, and skilled nursing, it is assumed that related provider payments and Medicare Part D State Phase Down Contribution (“Clawback”) have also been included as they are costs of persons eligible for nursing home care. BEAS states that in FY 2009 the budget amounts designated by RSA 167:18-a for county payment total $117,177,329. Less caps and credits totaling $21,412,015, counties would be responsible for a net amount of $95,765,314 in FY 2009 based on current law (as amended by Chapter 263, Laws of 2007). This bill would require the state to be responsible for these costs resulting in an increase in state expenditures and decrease in county expenditures beginning in FY 2009. Assuming annual increases of 2%, BEAS estimates this bill would increase state expenditures and decrease county expenditures by $95,765,314 in FY 2009, $97,680,620 in FY 2010, $99,634,232 in FY 2011, and $101,626,917 in FY 2012.
The Department’s Division of Children Youth and Family (DCYF) states this bill would require counties to pay 75% of the non-federal share of the costs of court ordered services and placements in delinquency, abuse and neglect, and CHINS cases, whereas current statute (as amended by Chapter 263, Laws of 2007) does not require the counties to contribute toward these costs beginning in FY 2009. DCYF estimates the total cost of court ordered services and placements in these cases will be $38,967,856 in FY 2009. Under this bill, the state would be responsible for 25% of these costs or $9,741,964 (a decrease of $29,225,892), and the counties would be liable for 75% of these costs or $29,225,892. Assuming a 3% annual increase in these costs, DCYF estimates this bill will decrease state expenditures and increase county expenditures by $29,225,892 in FY 2009, $30,102,669 in FY 2010, $31,005,749 in FY 2011, and $31,935,921 in FY 2012. The Department estimates the fiscal impact on state and county expenditures as follows:
State Expenditures
FY 2009 FY 2010 FY 2011 FY 2012
DFA (OAA/APTD) $(17,791,200) $(19,240,502) $(20,815,752) $(22,528,523)
BEAS (Long-Term Care) 95,765,314 97,680,620 99,634,232 101,626,917
DCYF (Juvenile Services) (29,225,892) (30,102,669) (31,005,749) (31,935,921)
Total Increase/(Decrease) $48,748,222 $48,337,449 $47,812,731 $47,162,473
County Expenditures
FY 2009 FY 2010 FY 2011 FY 2012
DFA (OAA/APTD) $17,791,200 $19,240,502 $20,815,752 $22,528,523
BEAS (Long-Term Care) (95,765,314) (97,680,620) (99,634,232) (101,626,917)
DCYF (Juvenile Services) 29,225,892 30,102,669 31,005,749 31,935,921
Total Increase/(Decrease) $(48,748,222) $(48,337,449) $(47,812,731) $(47,162,473)
The New Hampshire Association of Counties states this bill repeals various statutory changes to the county and state cost sharing arrangement relative to long-term care services and provider payments for Medicaid clients, and relative to the cost of juvenile services for abuse and neglect, delinquency, and CHINS cases that were to go into effect on July 1, 2008. This bill also makes changes to the cost sharing arrangements currently in place. Current law provides that the counties are financially responsible for 50% of the non-federal share of the costs of long-term care services, including provider payments. The counties are also responsible for Clawback payments, and 50% of the payments of OAA and APTD. The bill proposes that the state would be responsible for the entire non-federal share of the costs of nursing homes, skilled care, home and community based care (HCBC), and provider payments. The state would also be responsible for Clawback payments. For FY 2009, the Association states this bill would increase state expenditures and decrease county expenditures for nursing home care, HCBC, skilled nursing, provider payments, and Clawback by approximately $71 million. The bill would also increase county expenditures and decrease state expenditures for OAA and APTD by approximately $8 million in FY 2009. However, because the OAA and APTD surcharges are a flat number based on the number of clients, the future Medicaid cost to counties is indeterminable at this time but could be significant. The Association also states this bill would increase county expenditures and decrease state expenditures for juvenile services by approximately $27 million in FY 2009. The Association states the net impact of this bill would be a decrease in county expenditures and an increase in state expenditures of approximately $36 million, without taking into account a possible increase in the liability for the OAA and APTD surcharge. The Association states they are unable to determine the exact fiscal impact at this time.