Revision: Jan. 21, 2010, midnight
SB 450-FN – AS INTRODUCED
2010 SESSION
01/10
SENATE BILL 450-FN
AN ACT relative to costs and expenditures at the department of health and human services.
SPONSORS: Sen. Sgambati, Dist 4; Sen. D'Allesandro, Dist 20; Sen. Gallus, Dist 1; Sen. Janeway, Dist 7
This bill:
I. Consolidates the amount to be reduced by the department of health and human services, as required under HB 1-A of the 2009 legislative session, for the biennium instead of for each fiscal year.
II. Exempts certain rates for services, placements, and programs for children and families from RSA 541-A.
III. Clarifies the administration of the New Hampshire employment program.
IV. Makes the funded family assistance program (FANF) permissive rather than mandatory.
V. Requires recipients of medical assistance to name the department as beneficiary of all life insurance policies, except under certain circumstances.
VI. Clarifies services, placements, and programs for children in the state services system.
VII. Allows the department of health and human services to make a claim for recovery of assistance for a deceased recipient from the division of abandoned property.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
10-2705
01/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Ten
AN ACT relative to costs and expenditures at the department of health and human services.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Department of Health and Human Services; Reduction in Appropriation. Amend 2009, 143:9 to read as follows:
143:9 Department of Health and Human Services; Reduction in Appropriation. The department of health and human services is hereby directed to reduce state general fund appropriations from any line by [$7,359,331 for the fiscal year ending June 30, 2010, and $12,199,900 for the fiscal year] $19,559,231 for the biennium ending June 30, 2011. Any direct services to New Hampshire citizens shall be excluded from these reductions unless expressly approved by the fiscal committee of the general court and the governor and council. The department shall provide a quarterly report of reductions made under this section to the fiscal committee of the general court and the governor and council.
2 Department; Powers and Duties; Publication of Rates of Reimbursement Exempt From Rulemaking. Amend RSA 170-G:4, XVII to read as follows:
XVII. Establish rates for all services, placements and programs which are paid for by the department pursuant to RSA 169-B:40, 169-C:27, 169-D:29, and any services required to be provided by the department pursuant to paragraph II of this section. When educational aspects are present in any service, placement or program subject to rate-setting by the department, rates for the educational component shall be addressed jointly by the department and the department of education. Publication of rates of reimbursement shall be exempt from the provisions of RSA 541-A.
3 New Paragraph; Administrative Procedure Act; Exception Added. Amend RSA 541-A:21 by inserting after paragraph VI the following new paragraph:
VII. RSA 170-G:4, XVII, relative to the publication of rates for services, placements, and programs which are paid for by the department of health and human services pursuant to RSA 169-B:40, RSA 169-C:27, and RSA 169-D:29 shall be exempt from RSA 541-A.
4 Administration of the New Hampshire Employment Program; Duties; Rulemaking. Amend RSA 167:83, V to read as follows:
V. The commissioner [shall] may enter into an agreement or contract with the commissioner of the department of employment security to carry out the employment program and may delegate authority and duties for the employment program to the commissioner of the department of employment security and other state agencies. The commissioner shall adopt rules for the employment program [in consultation with the commissioner of the department of employment security].
5 Non-TANF Funded Program for 2-Parent Families With Dependent Children. Amend RSA 167:77-e to read as follows:
167:77-e Assistance Program for 2-Parent Families with Dependent Children. [By October 1, 2008,] The department [shall] may establish a non-TANF, state-funded financial assistance program for 2-parent needy families with dependent children in which one parent is underemployed or unemployed. With the exception of parental underemployment or unemployment, client eligibility and program requirements and administration shall be in accordance with this chapter and the rules adopted under this chapter. In order to meet the federal work participation rate and avoid federally-imposed penalties, the commissioner may add additional groups of families to this state-funded, financial assistance program as funding permits and also may transfer cases back to the TANF program, pursuant to rules adopted under RSA 541-A.
6 Eligibility for Medical Assistance. Amend RSA 167:4, IV(c) to read as follows:
(c) Notwithstanding any provision of law to the contrary, for purposes of medicaid eligibility, investment in life insurance policies with cash surrender, benefit, or face value in excess of $1,500 shall be limited to policies that ensure payment to the state of New Hampshire of all the proceeds of the policy in excess of amounts spent on burial up to the total of medicaid expenditures made on behalf of the individual, except that life insurance policies which name the Medicaid recipient’s spouse who remains living in the community as the only beneficiary shall be exempt from this eligibility requirement.
7 New Section; Delinquent Children; Determination of Appropriate Services Placements, and Programs. Amend RSA 169-B by inserting after section 19-c the following new section:
169-B:19-d Determination of Appropriate Services, Placements, and Programs. Notwithstanding any provision of law to the contrary, the court shall, at the dispositional hearing under RSA 169-B:19, order the services, placements, and programs as recommended by the department under RSA 169-B:19, I(c) and RSA 169-B:19, I(f). Forty-five days from the dispositional hearing, or at any time thereafter, the court may, after hearing and in its discretion, review or modify the order for services, placements, or programs provided to the minor or the minor’s family under this section.
8 New Section; Child Protection Act; Determination of Appropriate Services, Placements, and Programs. Amend RSA 169-C by inserting after section 19-e the following new section:
169-C:19-f Determination of Appropriate Services, Placements, and Programs. Notwithstanding any provision of law to the contrary, the court shall, at the dispositional hearing under RSA 169-C:19, order the services, placements and programs as recommended by the department under RSA 169-C:19, I (b), (c) and (d), RSA 169-C:19, III (a), and RSA 169-C:19, IV. Forty-five days from the dispositional hearing, or at any time thereafter, the court may, after hearing and in its discretion, and notwithstanding RSA 169-C:22, review or modify the order for services, placements, or programs provided to the child or the child’s family under this section.
9 New Section; Children in Need of Services; Determination of Appropriate Services, Placements, and Programs. Amend RSA 169-D by inserting after section 17-c the following new section:
169-D:17-d Determination of Appropriate Services, Placements, and Programs. Notwithstanding any provision of law to the contrary, the court shall, at the dispositional hearing under RSA 169-D:17, order the services, placements, and programs as recommended by the department under RSA 169-D:17, I (a)(1), RSA 169-D:17, I(b)(2), and RSA 169-D:17, I(e). Forty-five days from the dispositional hearing, or at any time thereafter, the court may, after hearing and in its discretion, and notwithstanding RSA 169-D:19, review or modify the order for services, placements, or programs provided to the child or the child’s family under this section.
10 Report Required. On or before November 1, 2011, the department of health and human services and the administrative office of the district and family division courts shall file a report on the efficacy of the process established under RSA 169-B:19-d, RSA 169-C:19-f, and RSA 169-D:17-d for the delivery of timely and cost effective services, placements, and programs for children and their families. The report shall be filed with the speaker of the house of representatives, the president of the senate, the governor, the chairperson of the house children and family law committee, the house clerk, the senate clerk and the state library and shall make recommendations, if appropriate, for future legislation to address these issues.
11 Authorizing the Department of Health and Human Services to File Claims for Medical and Financial Assistance Against Abandoned Property Held by the Treasury; Filing of Claim With Administrator. Amend RSA 471-C:26, I(c)(2)(3) to read as follows:
(2) Except as provided in subparagraphs (5)-(7), in the case of a closed estate where the unclaimed property is valued at less than $5,000 and does not include securities in share form, in accordance with the final distribution of assets as approved by the probate court.
(3) Except as provided in subparagraphs (5)-(7), in the absence of an open estate or probate court decree of final distribution, and the unclaimed property is valued at less than $5,000 and does not include securities in share form, by the surviving spouse of the deceased owner, or, if there is no surviving spouse, then to the next of kin in accordance with the provisions of RSA 561:1.
12 New Subparagraphs; Filing of Claim With Administrator. Amend RSA 471-C:26, I(c) by inserting after subparagraph (4) the following new subparagraphs:
(5) Before distributing any unclaimed property pursuant to subparagraphs (2) and (3), the administrator shall first ensure that the department of health and human services does not have a claim for medical and or financial assistance paid on behalf of the deceased owner.
(6) In the event that the department of health and human services has a claim for medical and or financial assistance paid on behalf of the deceased owner, the department may submit a claim for such assistance using an affidavit developed by the administrator that ensures that:
(A) No individual has moved to probate the deceased owner’s estate through which the department could assert its claim or probate administration for the deceased owner had been open and no individual has moved to reopen the estate through which the department could assert its claim;
(B) The department does not believe, based on the information available to it, there are known expenses for the deceased owner’s necessary funeral and burial; and
(C) Based on all facts known to the department, its recovery of this abandoned property is not limited by the prohibitions to recovery as set forth in 42 U.S.C. section 1396p and RSA 167:16-a, IV.
(7) If the department of health and human services has made a claim against a deceased owner’s unclaimed property as provided in subparagraph (6), under no circumstances shall the administrator distribute to the department more than the claimed amount.
13 Repeal. 2009, 144:211, relative to community mental health centers; administrative requirements suspended, is repealed.
14 Effective Date. This act shall take effect upon its passage.
LBAO
10-2705
Revised 01/21/10
SB 450 FISCAL NOTE
AN ACT relative to costs and expenditures at the department of health and human services.
FISCAL IMPACT:
The Department of Health and Human Services states this bill would have an indeterminable fiscal impact on state revenue and expenditures, and county revenue in FY 2010 and FY 2011. This bill will have no fiscal impact on county and local expenditures, or local revenue.
METHODOLOGY:
Section 1 - The Department of Health and Human Services (DHHS) states Chapter 143:9, Laws of 2009 (HB 1) requires the Department to reduce state general fund appropriations by $7,359,331 in FY 2010 and $12,199,900 in FY 2011. The proposed bill would remove the annual amounts, and require a reduction of $19,559,231 over the FY 2010-2011 biennium. This would allow the Department flexibility in determining how much to reduce each year. State expenditures would be impacted to the extent annual reduction amounts differ from the amounts contained in Chapter 143.
Sections 2 and 3 – The Department states these sections would exempt publication of the rates for services placements and programs under RSA 169-B, C & D from the provisions of RSA 541-A and should have no fiscal impact on the Department.
Section 4 – The Department states RSA 167:83, V currently requires the commissioner of DHHS to enter into a contract with the Department of Employment Security (DES) to carry out the New Hampshire Employment Program (NHEP). This section would amend RSA 167:83, V to make such contracting optional at the discretion of the Commissioner of DHHS. The change, in and of itself, has no fiscal impact as it does not actually change the way NHEP is administered. If DHHS were to actually exercise the option to no longer contract with DES to carry out the NHEP, there could potentially be a fiscal impact at that time.
Section 5 – The Department states this section would make the Non-TANF Funded Program for 2-Parent Families with Dependent Children permissive rather than mandatory. This section may decrease state general fund expenditures to the extent the Department decides not to continue the program. The FY 2010-FY 2011 operating budget includes state general fund appropriations of $5,889,537 in each fiscal year for this program.
Section 6 – The Department states RSA 167:4, IV(c) currently requires recipients of medical assistance to name the state of New Hampshire as the beneficiary of any life insurance policy that has a cash surrender value greater than $1,500 as a condition of eligibility. The proposed legislative change would amend RSA 167:4, IV(c) to require recipients of medical assistance to name the state of New Hampshire as primary beneficiary of any life insurance policy that has a cash surrender value, benefit or face value in excess of $1,500 unless the recipient has a spouse who remains living in the community as the only beneficiary. Policies must ensure payment to the state of New Hampshire of all the proceeds of the policy in excess of amounts spent on burial up to the total of Medicaid expenditures made on behalf of the individual. There are currently 1,919 Medicaid recipients who own life insurance policies that currently have a cash surrender value, benefit or face value in excess of $1,500 and who are not currently required to name the state of New Hampshire as primary beneficiary. It is assumed that approximately 4% of the 1,919 or 77 Medicaid recipients with life insurance have spouses that live in the community. These individuals will not be required to name the State of New Hampshire as primary beneficiary. As a result, the approximate number of recipients that will be affected by the change is 1,842 (1,919 - 77). The average face value of life insurance policies owned by the 1,919 Medicaid recipients is $16,000. The Department estimates the average cost for a funeral would be $6,000 which would result in $10,000 in insurance available for recovery. The DHHS Office of Recoveries handled a total of 352 estates in FY 2009. Almost all of these estates were State Supplement Program Medicaid (Old Age Assistance, Aid to the Needy Blind, or Aid to the Permanently and Totally Disabled) recipients. The 352 estates represent 1.5% of the adult category caseload in any given state fiscal year. As a result, it is assumed that 1.5% of the 1,842 Medicaid recipients with life insurance (28) will be subject to recovery in any given state fiscal year. The Department estimates recovery revenue will increase by $280,000 annually (28 recipients X $10,000 average available insurance). In FY 2009, the Office of Recoveries recovered a total of $4.9 million. Of the $4.9 million, $3.8 million (78%) represented long-term care cases and $1.1 million (22%) represented recoveries from other Medicaid cases. Using these percentages, the Department estimates the additional recovery revenue will be distributed as follows -
• 78% of the additional revenue will be for long-term care cases:
o Total revenue: $218,400
o Federal share: (50%): $109,200
o County share: (38.41%): $83,887
o State share (11.59%): $25,313
• 22% of the additional revenue will be for other Medicaid cases:
o Total revenue: $61,600
o Federal share (50%): $30,800
o State share (50%): $30,800
• Total additional revenue:
o Federal share: $140,000
o County share: $83,887
o State share: $56,113
Sections 7 and 9 – The Department believes that Treatment Authorization for Program Services (TAPS) will reduce costs related to Children in Need of Services (CHINS) and delinquents rehabilitative services. Currently Judges vary from Division of Juvenile Justice Service (DJJS) recommended treatment plan for a significant number of youths served. Some of these variances could result in high, medium, and/or low cost savings if the original DJJS treatment plan was followed to begin with. Using calculations based on the FY 2010 average monthly expenditures of placements and other services currently provided by DJJS, the Department estimates the maximum monthly cost reduction for all levels of cost savings at $69,588. Assuming that the proposed changes will be effective for only 2 months in FY 2010, and inflation of 2% annually, the Department estimates the fiscal impact as follows –
Total General Federal Other
Funds Funds (53%) Funds (42%) Funds (5%)
FY 2010 $139,117 $73,732 $58,429 $6,956
FY 2011 $851,395 $451,239 $357,586 $42,570
FY 2012 $868,089 $460,087 $364,597 $43,405
FY 2013 $884,783 $468,935 $371,609 $44,239
FY 2014 $901,477 $477,783 $378,620 $45,074
Section 8 – The Department states this section provides that the court shall adopt, in the first instance, the Department’s recommendations for services placements and programs at the dispositional hearing in cases under RSA 169-C. The fiscal impact of this change is difficult to estimate, as the type, number and cost of these services can vary significantly with any given case, and the difference between the services recommended by the Department and those that would otherwise have been ordered by the court is somewhat speculative. The Department, however, assumes that the change will result in an indeterminate decrease in the costs for court ordered services.
Section 10 - The Department states this section requires the Department to file a report on the efficacy of the process established elsewhere in the bill for the timely and cost effective delivery of services placements and programs under RSA 169-B, C & D. The Department estimates that preparation of the report can be done with existing resources.
Sections 11 and 12 – The Department states these sections will make certain changes to RSA 471-C:26 relative to claims for abandoned property to allow the state to claim against abandoned property where the state has paid medical or financial assistance for the benefit of the deceased owner of the property. This change in the law would result in an increase in revenue of an indeterminable amount.
Section 13 – The Department states this section would repeal the Chapter 144:211, Laws of 2009 that requires the Commissioner of DHHS to provide a report to the HHS Oversight Committee detailing administrative and reporting requirements for community mental health centers that could be suspended without jeopardizing public health and safety. The report was to be submitted by September 30, 2009. The Commissioner submitted a report to the HHS Oversight Committee on September 29, 2009 that described an ongoing review of administrative requirements on the mental health centers. There will no fiscal impact as a result of this repeal.