Revision: Feb. 11, 2010, midnight
HB 646-FN-LOCAL - AS AMENDED BY THE HOUSE
10Feb2010… 0192h
2009 SESSION
10/01
HOUSE BILL 646-FN-LOCAL
AN ACT relative to caps on total billings to counties for nursing home care 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
This bill requires the reduction of the annual caps on total billings to counties in the same percentage as any statewide nursing home rate reduction attributable to application of a budget neutrality factor by the department of health and human 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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
10Feb2010… 0192h
09-0435
10/01
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Nine
AN ACT relative to caps on total billings to counties for nursing home care services.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Subparagraph; County Nursing Home; Reimbursement of Funds; Adjustment of Caps. Amend RSA 167:18-a, II by inserting after subparagraph (b) the following new subparagraph:
(c) The caps on total billings established in subparagraph (a) shall be reduced for each state fiscal year in the same percentage as any average statewide nursing home rate reduction attributable to application of a budget neutrality factor from the rates in effect on July 1 of each state fiscal year.
2 Effective Date. This act shall take effect upon its passage.
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)
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
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