HB646 (2009) Detail

Relative to county and state obligations for costs for nursing care and services, and for court orders for children services.


HB 646-FN-LOCAL - AS INTRODUCED

2009 SESSION

09-0435

10/01

HOUSE BILL 646-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. Weed, Ches 3; Rep. Vachon, Straf 3; Rep. Cooney, Graf 7; Rep. Theberge, Coos 4

COMMITTEE: Municipal and County Government

ANALYSIS

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

09-0435

10/01

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Nine

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 RSA 167:18-a is repealed and reenacted to read as follows: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 Delinquency Orders; County Liability. RSA 169-B:40, II-VI are repealed and reenacted to read as follows:

II. Upon the issuance of the order in paragraph I, the court shall send notice to the state and relevant county. The state and relevant county may, within 30 days from the receipt of notice, request a hearing on the issues of the cost or appropriateness of services, or recovery. At such hearing, the court shall provide all financial information, including names and addresses of persons chargeable by law for the minor’s support and necessities, to the state and relevant county.

III. The office of reimbursements acting on behalf of Laconia developmental services and the New Hampshire hospital is authorized to compromise or reduce any expense to be charged to the state.

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 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 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.

VI. Notwithstanding any subsequent acts of delinquency or other acts committed by the minor which bring the minor to the attention of a district court, the county having liability for the minor pursuant to paragraph IV shall remain the county liable for the minor until the person reaches 18 years of age or the court’s jurisdiction is ended, whichever comes first.

VII. If the person responsible for paying reimbursements to the county under paragraph V is financially able to pay such reimbursements but fails to make such payments, the county may apply to the district court for a lien on such person’s real or personal property for the amount of reimbursements due.

VIII.(a) For the adoptive parent or prospective adoptive parent of a child in the custody of the state whose birth parents have consented to the adoption, relinquished their parental rights to the department, or the parental rights of whose birth parents were terminated pursuant to a petition brought by the department, authorized agency, or foster parent, pursuant to RSA 170-C:4, the state shall have no right of action against such adoptive parent or prospective adoptive parent for the expenses of services, placements, and programs provided pursuant to RSA 169-B, 169-C, or 169-D after the adoption.

(b) If the department determines that the adoptive parent has been convicted of sexual or physical abuse of the adopted child pursuant to RSA 631 or 632-A, or the adoptive parent has misappropriated adoption subsidy moneys, the adoptive parent shall be responsible for payment for subsequent services, placements, and programs provided pursuant to RSA 169-B, 169-C, or 169-D after the adoption. A determination of misappropriation is subject to the provisions of RSA 126-A:5, VIII.

IX. Notwithstanding any provision of law to the contrary, no county government shall be charged per diem rates for its portion of costs of placement of juveniles at the youth development center, the youth detention services unit, and, when applicable, the Tobey School, which are based upon an annual average daily census at each unit which is less than 80 percent of the unit’s capacity.

3 Abuse and Neglect; County Liability. RSA 169-C:27, II-VI are repealed and reenacted to read as follows:

II. Upon the issuance of the order in paragraph I, the court shall send notice to the state and relevant county. The state and relevant county may, within 30 days from receipt of notice, request a hearing on the issues of the cost or appropriateness of services, or recovery. At such hearing, the court shall provide all financial information, including names and addresses of persons chargeable by law for the child’s support and necessities, to the state and relevant county.

III. The office of reimbursements acting on behalf of Laconia developmental services and the New Hampshire hospital is authorized to compromise or reduce any expense to be charged to the state.

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 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 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.

VI. Notwithstanding any subsequent acts committed by the child which bring him or her to the attention of a district court, the county having liability for the child pursuant to paragraph IV shall remain the county liable for the child until the person reaches 18 years of age or the court’s jurisdiction is ended, whichever comes first, unless the court’s jurisdiction has been extended pursuant to RSA 169-C:4, II.

VII. If the person responsible for paying reimbursements to the county under paragraph V is financially able to pay such reimbursements but fails to make such payments, the county may apply to the district court for a lien on such person’s real or personal property for the amount of reimbursements due.

VIII.(a) For the adoptive parent or prospective adoptive parent of a child in the custody of the state whose birth parents have consented to the adoption, relinquished their parental rights to the department, or the parental rights of whose birth parents were terminated pursuant to a petition brought by the department, authorized agency, or foster parent, pursuant to RSA 170-C:4, the state shall have no right of action against such adoptive parent or prospective adoptive parent for the expenses of services, placements, and programs provided pursuant to RSA 169-B, 169-C, or 169-D after the adoption.

(b) If the department determines that the adoptive parent has been convicted of sexual or physical abuse of the adopted child pursuant to RSA 631 or 632-A, or the adoptive parent has misappropriated adoption subsidy moneys, the adoptive parent shall be responsible for payment for subsequent services, placements, and programs provided pursuant to RSA 169-B, 169-C, or 169-D after the adoption. A determination of misappropriation is subject to the provisions of RSA 126-A:5, VIII.

IX. Notwithstanding any provision of law to the contrary, no county government shall be charged per diem rates for its portion of costs of placement of juveniles at the youth development center, the youth detention services unit, and, when applicable, the Tobey School, which are based upon an annual average daily census at each unit which is less than 80 percent of the unit’s capacity.

4 Children in Need of Services; County Liability for Costs. RSA 169-D:29, II-VI are repealed and reenacted to read as follows:

II. Upon the issuance of the order in paragraph I, the court shall send notice to the state and relevant county. The state and relevant county may, within 30 days from receipt of notice, request a hearing on the issues of the cost or appropriateness of services, or recovery. At such hearing, the court shall provide all financial information, including names and addresses of persons chargeable by law for the child’s support and necessities, to the state and relevant county.

III. The office of reimbursements acting on behalf of Laconia developmental services and the New Hampshire hospital is authorized to compromise or reduce any expense to be charged to the state.

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 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 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.

VI. Notwithstanding any subsequent acts committed by the child which bring him or her to the attention of a district court, the county having liability for the child pursuant to paragraph IV shall remain the county liable for the child until the person reaches 18 years of age or the court’s jurisdiction is ended, whichever comes first.

VII. If the person responsible for paying reimbursements to the county under paragraph V is financially able to pay such reimbursements but fails to make such payments, the county may apply to the district court for a lien on such person’s real or personal property for the amount of reimbursements due.

VIII. Upon request by the adoptive parent of a child whose birth parents relinquished their parental rights to the department or the parental rights of whose birth parents were terminated pursuant to a petition brought by the department, the state, acting through the commissioner, may waive its right of action against such adoptive parent for all or a portion of the expenses of services, placements, and programs provided pursuant to RSA 169-B, 169-C or 169-D after the adoption. The department shall adopt rules under RSA 541-A to establish the procedure to be followed to obtain a waiver of parental reimbursement pursuant to this paragraph.

(a) For the adoptive parent or prospective adoptive parent of a child in the custody of the state whose birth parents have consented to the adoption, relinquished their parental rights to the department, or the parental rights of whose birth parents were terminated pursuant to a petition brought by the department, authorized agency, or foster parent, pursuant to RSA 170-C:4, the state shall waive its right of action against such adoptive parent or prospective adoptive parent for the expenses of services, placements, and programs provided pursuant to RSA 169-B, 169-C, or 169-D after the adoption.

(b) If the department determines that the adoptive parent has been convicted of sexual or physical abuse of the adopted child pursuant to RSA 631 or 632-A, or the adoptive parent has misappropriated adoption subsidy moneys, the adoptive parent shall be responsible for payment for subsequent services, placements, and programs provided pursuant to RSA 169-B, 169-C, or 169-D after the adoption. A determination of misappropriation is subject to the provisions of RSA 126-A:5, VIII.

IX. Notwithstanding any provision of law to the contrary, no county government shall be charged per diem rates for its portion of costs of placement of juveniles at the youth development center, the youth detention services unit, and, when applicable, the Tobey School, which are based upon an annual average daily census at each unit which is less than 80 percent of the unit’s capacity.

5 Effective Date. This act shall take effect July 1, 2009.

LBAO

09-0435

01/23/09

HB 646-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 the New Hampshire Association of Counties state this bill would increase state expenditures and decrease county and local expenditures by an indeterminable amount in FY 2010 and each year thereafter. This bill would decrease state revenue and increase county revenue by an indeterminable amount in FY 2010 and each year thereafter. This bill would have no fiscal impact on local revenue.

METHODOLOGY:

    The Department of Health and Human Services (DHHS) states this bill would change the state and county obligations for payments for the costs of nursing home care, home and community based care (HCBC), old age assistance (OAA), aid to the permanently and totally disabled (APTD), and court orders for delinquency, abuse and neglect, an children in need of services. The Department used agency phase maintenance budgets to estimate the costs in FY 2010 and FY 2011. For FY 2012 and FY 2013 estimates, the Department assumed nursing home expenditures would increase by 2.5% annually; HCBC expenditures would increase by 12% annually; OAA expenditures would increase by 11% annually; APTD expenditures would increase by 7.5% annually; Tobey School expenditures would increase by 2.9% annually; Division for Children, Youth and Families (DCYF) expenditures would increase by 3% annually; and Youth Detention Center (YDC) and Youth Detention Services Unit (YDSU) would increase by 5% annually. The Department also assumes that there will be no county credit or county cap limit on payments upon passage of this bill. The Department states that Tobey School expenditures are also shared with the local school districts, therefore there would be a fiscal impact on local expenditures as well. The Department estimates the fiscal impact as follows:

                      FY 2010 FY 2011 FY 2012 FY 2013

    State General Fund $36,997,319 $35,596,254 $32,381,546 $28,973,438

    County Expenditures $(36,814,887) $(35,410,290) $(32,190,245) $(28,776,647)

    Local Expenditures $(182,432) $(185,964) $(191,301) $(196,791)

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                      01/23/09

    The Department states that counties will assume responsibility of processing DCYF/Division for Juvenile Justice Services (DJJS) service authorizations, board and care invoices, and attorney and guardian ad litem bills as they did prior to July 1, 2008. The counties will receive the 15% administrative fee for the collection of parental reimbursement, and if the counties assume responsibilities for parental reimbursement, the Department will no longer need to have staff assigned to this task. The costs to the Department are estimated at $585,466 in FY 2010, $606,537 in FY 2011, $628,372 in FY 2012, and $650,994 in FY 2013. These costs are split between the federal government and parental reimbursement fees. The Department states the annual amount of revenue received from parental reimbursements will remain at the $1.5 million level. Also, DCYF will need to retain two staff to identify which parental reimbursement claims are due to the state and which are due to the counties, and to identify claims deducted by the counties, and therefore should not be reimbursed to the counties. The exact fiscal impact on state and county revenue and expenditures cannot be determined at this time.

    The New Hampshire Association of Counties states this bill would make the state liable for 100% of the non-federal share of long-term care costs for Medicaid recipients in nursing homes and HCBC beginning in FY 2010. Current law provides that the counties are liable for 100% of the non-federal share of those costs and the liability of the counties for those costs is capped at $105M. Therefore, in FY 2010 the counties would see a decrease in expenditures for long-term care of $105M. There are no caps in place for FY 2011, and without knowing what cap the Legislature might enact thereafter, the Association can only state what the estimated decrease would be without the caps. The Association estimates the decrease in county long-term care expenditures of approximately $140M in FY 2011, $152M in FY 2012, and $165M in FY 2013. Under current law the counties are not liable for the costs of OAA and APTD cash or medical payments. This bill would make the counties responsible for 100% of those costs for those recipients not in nursing homes or HCBC. Under prior law, the counties were liable to reimburse the state at the rate of $27 per month for each recipient of OAA, and $52 per month for each recipient of APTD. The Association estimates these reimbursements were approximately 50% of the entire cost. Therefore the Association estimates that under the 100% liability provision county expenditures would increase by $26.6M in FY 2010, $27.8M in FY 2011, $29.4M in FY 2012, and $31M in FY 2013. The bill also makes counties liable for the costs of juvenile court placements and services to the extent of 75% of the cost thereof. The counties are not liable for those costs under current law. As a result, there would be an

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                      01/23/09

    increase in county expenditures of $41.7M in FY 2010, $42.6M in FY 2011, $44.1M in FY 2012, and $45.3M in FY 2013. The estimated decrease in county expenditures, and corresponding increase in state expenditures is as follows:

                      FY 2010 FY 2011 FY 2012 FY 2013

    Long-Term Care $(105M) $(140M) $(152M) $(165M)

    OAA/APTD $26.6M $27.8M $29.4M $31M

    Juvenile Services $41.7M $42.6M $44.1M $45.3M

    Net County Impact $(36.7M) $(69.6M) $(78.5M) $(88.7M)

    Net State Impact $36.7M $69.6M $78.5M $88.7M