Revision: Jan. 12, 2010, midnight
SB 343-FN – AS INTRODUCED
2010 SESSION
01/09
SENATE BILL 343-FN
AN ACT relative to Medicaid managed care.
SPONSORS: Sen. Bradley, Dist 3; Sen. Downing, Dist 22; Sen. Letourneau, Dist 19; Sen. Gallus, Dist 1; Rep. Packard, Rock 3; Rep. Boutin, Merr 9; Rep. Wendelboe, Belk 1
COMMITTEE: Health and Human Services
This bill requires the department of health and human services to establish a mandatory Medicaid managed care program for all Medicaid clients. Under this bill, the department shall develop a waiver to implement the program to present to the fiscal committee of the general court before seeking final approval from the federal Centers for Medicare and Medicaid Services to implement the program.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
10-2733
01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Ten
AN ACT relative to Medicaid managed care.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Medicaid Managed Care Program.
I. The department of health and human services shall enter into a contractual agreement with one or more managed care organizations to provide managed care services for all Medicaid recipients, including the elderly, those meeting federal supplemental security income and state standards for disability, and those who are also currently enrolled in Medicare. Services provided pursuant to such contractual agreement may include, but not be limited to, care coordination, utilization management, disease management, pharmacy benefit management, provider network management, quality management, and customer services. To implement the requirements under this section, the department shall develop a Medicaid waiver to support the Medicaid managed care program for Medicaid clients. The department shall submit the appropriate waivers, state plan amendments and federal applications, including but not limited to, waiver requests authorized pursuant to sections 1115 and 1915 of the Federal Social Security Act, or successor provisions, as the department shall deem necessary to secure appropriate federal financial support for the cost of the program. The waivers, state plan amendments, and federal applications shall authorize mandatory managed care for Medicaid recipients residing in all areas of the state, including the elderly, those meeting federal supplemental security income and state standards for disability, and those who are also currently enrolled in Medicare. The department shall present the proposed waivers, state plan amendments and federal applications to the fiscal committee of the general court prior to submission for final approval of the federal Centers for Medicare and Medicaid Services (CMS). The department shall provide periodic reports to the fiscal committee of the general court throughout the waiver development, approval, and implementation processes. The department shall seek input from health care providers and the public in the course of developing the waiver.
II. For the purposes of this act, a “managed care organization” means an entity that is authorized by law to provide covered health services on a capitated risk basis and arranges for the provision of medical assistance services and supplies and coordinates the care of Medicaid recipients residing in all areas of the state, including the elderly, those meeting federal supplemental security income and state standards for disability, and those who are also currently enrolled in Medicare.
III. The department, in applying for a waiver, state plan amendment, or other federal authorization to implement the provisions of this act, shall request authority from the Secretary of Health and Human Services to combine Medicaid and Medicare funding for service delivery to eligible individuals who are also eligible for Medicare. Implementation of these programs may begin without authority to include Medicare funding.
IV. The following categories of individuals shall not be required to enroll in the managed care program established under this act:
(a) An individual dually eligible for medical assistance and benefits under the federal Medicare program and enrolled in a Medicare managed care plan offered by an entity that is also a managed care organization;
(b) HIV positive individuals;
(c) Persons with serious mental illness and abused children and adolescents with serious emotional disturbances, as defined in RSA 169-C; and
V. Individuals determined to be eligible for nursing home services and residing in a nursing facility.
2 Effective Date. This act shall take effect upon its passage.
LBAO
10-2733
01/06/10
SB 343-FN - FISCAL NOTE
AN ACT relative to Medicaid managed care.
FISCAL IMPACT:
The Department of Health and Human Services states this bill may have an indeterminable fiscal impact on state and county expenditures in FY 2010 and each year thereafter. This bill will have no fiscal impact on state, county, and local revenue and local expenditures.
METHODOLOGY:
The Department of Health and Human Services states this bill directs the Department to submit a Medicaid waiver for the purposes of making New Hampshire’s Medicaid program subject to operation by a managed care entity with mandatory participation by Medicaid recipients. The Department states Medicaid programs typically explore managed care in an effort to reduce costs. Last year, DHHS requested that Milliman, Inc., a leading health care actuarial firm, review New Hampshire’s Medicaid claims and conduct actuarial analysis to determine the viability of moving to a managed care model. Federal law requires that states that utilize a managed care model must offer choice to recipients. This requires at a minimum, two managed care organizations (MCO) to serve Medicaid enrollees guaranteeing enrollees always have an option to utilize one or the other. This requirement is not waivable. Milliman concluded that several factors impact the ability of a state to achieve savings by utilizing Medicaid managed care. These factors include the state’s existing reimbursement rate structure, size of the Medicaid caseload, administrative costs and the ‘wrap-around’ responsibility. In New Hampshire, caseload, reimbursement and administrative costs have been comparatively low. States opting for managed care must wrap around and pay for all services required by federal law but which the MCO does not include in its benefit package. The Department states they are unable to determine the fiscal impact at this time given the complexities of the variables.