HB1526 (2010) Detail

Requiring the department of health and human services to establish a methodology for determining certain high cost long-term care cases.


CHAPTER 112

HB 1526 – FINAL VERSION

03Mar2010… 0681h

05May2010… 1879eba

2010 SESSION

10-2315

01/05

HOUSE BILL 1526

AN ACT requiring the department of health and human services to establish a methodology for determining certain high cost long-term care cases.

SPONSORS: Rep. Miller, Belk 3

COMMITTEE: Health, Human Services and Elderly Affairs

ANALYSIS

This bill requires the department of health and human services to establish a methodology for determining certain high cost long-term care cases.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03Mar2010… 0681h

05May2010… 1879eba

10-2315

01/05

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Ten

AN ACT requiring the department of health and human services to establish a methodology for determining certain high cost long-term care cases.

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

112:1 Program Management and Control Costs. Amend RSA 151-E:11, II to read as follows:

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 prior approval shall include a comparison of the mid-level or home-based care costs of the person with the costs of a facility qualified to provide any specialized services necessary for the proper care and treatment of the individual. 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.

112:2 New Paragraphs; Long-Term Care; Methodology Required. Amend RSA 151-E:11 by inserting after paragraph II the following new paragraphs:

III.(a) The methodology for determining the cost of care for recipients in the home and community-based care waiver program for the elderly and chronically ill shall include the cost of:

(1) Waiver program services; and

(2) Other medicaid long-term care services, including but not limited to personal care, home health services, physical therapy, occupational therapy, speech therapy, adult medical day program services, private duty nursing, and case management services.

(b) Such methodology shall not include services rendered for the treatment of an acute illness or injury.

IV. Pursuant to RSA 541-A, the commissioner of the department of health and human services, with prior reporting to the oversight committee on health and human services, shall adopt by rule:

(a) Methodologies for determining the cost and average annual cost of home-based care, mid-level care, and intermediate, skilled, or specialized nursing facility care, including:

(1) Bases for the methodologies;

(2) Identification of services considered in determining costs;

(3) Average annual costs based on the annual average number of recipients in the setting;

(4) The requirement that nursing facility care include both the initial Medicaid rate and supplemental rates paid through the Medicaid Quality Incentive Program; and

(5) The requirement that the nursing facility will include the cost for transitional case management.

(b) A process to identify persons in home-based or mid-level care whose costs are expected to exceed 80 percent of the average annual cost for the provision of services to a person in a nursing facility.

(c) A standard of review and process for prior approval by the commissioner, in accordance with paragraph II of this section, for the cases identified through the process in subparagraph (b).

112:3 Effective Date. This act shall take effect January 1, 2011.

Approved: June 1, 2010

Effective Date: January 1, 2011