HB652 (2011) Detail

Establishing a commission relative to Medicaid managed care.


HB 652-FN – AS INTRODUCED

2011 SESSION

11-1108

01/09

HOUSE BILL 652-FN

AN ACT establishing a commission relative to Medicaid managed care.

SPONSORS: Rep. Kurk, Hills 7

COMMITTEE: Finance

ANALYSIS

This bill establishes a commission to develop a managed care model for administering the Medicaid program and its enrollees to provide for managed care services for all Medicaid populations throughout New Hampshire consistent with the provisions of 42 U.S.C. 1396u-2. The commission shall issue a request for proposals to enter into contracts with vendors of models. Once the model is selected by the commission and the contract is signed and approved by the governor and council, the department of health and human services shall implement the contract.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

11-1108

01/09

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Eleven

AN ACT establishing a commission relative to Medicaid managed care.

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

1 New Chapter; Commission on Medicaid Managed Care. Amend RSA by inserting after chapter 126-U the following new chapter:

CHAPTER 126-V

COMMISSION ON MEDICAID MANAGED CARE

126-V:1 Commission Established; Membership.

I. There is hereby established a commission relative to Medicaid managed care. The members of the commission shall be as follows:

(a) Two members appointed by the speaker of the house of representatives.

(b) Two members appointed by the president of the senate.

(c) One member, appointed by the governor.

II. No member of this commission shall be a member of the general court or an employee of the state of New Hampshire.

126-V:2 Duties.

I. After consulting with the commissioner of the department of health and human services, the commission shall develop a request for proposals for one or more 5-year, capitated, all-risks, managed care contracts with a managed care organization for all services for all Medicaid populations throughout New Hampshire, unless the commission otherwise determines, consistent with the provisions of 42 U.S.C. 1396u-2. Services shall include all mandatory Medicaid covered services and may include, but shall not be limited to, care coordination, utilization management, disease management, pharmacy benefit management, provider network management, quality management, and customer services. The request for proposals may include mandatory dental services. The commissioner shall provide such outside consulting services as the commission may request. After consulting with the commissioner and receiving the approval of the fiscal committee of the general court, the commission shall, on behalf of the state, enter into one or more contracts with those vendors that demonstrate the greatest ability to satisfy the state’s need for value, quality, efficiency, innovation, and savings. The request for proposals shall be released no later than October 15, 2011. The vendors shall be selected no later than January 15, 2012 with final contracts submitted to the governor and council for approval no later than March 15, 2012. After the bidding process, the commission, in consultation with the commissioner shall establish a capitated rate based on the bids that is full risk to the vendors. The capitated rate shall be broken down rate cells for each population including, but not limited to, the persons eligible for temporary assistance to needy families (TANF), aid for the permanently and totally disabled (APTD), breast and cervical cancer program (BCCP), home care for children with severe disabilities (HC-CSD), and those residing in nursing facilities. The selected vendors providing the Medicaid services shall establish medical homes, and all Medicaid recipients shall receive their care through a medical home. In contracting for a managed care model and the various rate cells, the commission shall ensure no reduction in the quality of care of services provided to enrollees in the managed program and shall exercise all due diligence to maintain or increase the current level of quality of care provided. Once the contract is approved by the governor and council, the commissioner shall implement the provisions of the contract and this section. The target date for implementation of the contract is July 1, 2012. The commissioner may, in consultation with the fiscal committee, adopt rules, if necessary, to implement the provisions of this section. The commissioner shall, with the approval of the fiscal committee, seek all necessary and appropriate waivers to implement the provisions of this section.

II. The department of health and human services shall ensure that all eligible Medicaid members are enrolled in the managed care program under contract with the department no later than 12 months after the contract is awarded to the vendor or vendors of the managed care model.

III. For the purposes of this section, 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.

126-V:3 Chairperson; Quorum. The members of the commission shall elect a chairperson from among the members. The first meeting of the commission shall be called by the first-named member appointed by the speaker of the house of representatives. The first meeting of the commission shall be held within 5 days of the effective date of this section. Three members of the commission shall constitute a quorum.

2 Contingency. RSA 126-V as inserted by section 1 of this act shall be repealed on the date the contract is approved by the governor and council as required by RSA 126-V:2, I, which date shall be certified by the commissioner of the department of health and human services to the secretary of state and the director of legislative services.

3 Repeal. The following are repealed:

I. RSA 126-A:5, XIX, relative to Medicaid managed care.

II. RSA 126-V, relative to the commission on Medicaid managed care.

4 Effective Date.

I. Paragraph II of section 3 of this act shall take effect as provided in section 2 of this act.

II. The remainder of this act shall take effect upon its passage.

LBAO

11-1108

09/09/11

HB 652-FN - FISCAL NOTE

AN ACT establishing a commission relative to Medicaid managed care.

FISCAL IMPACT:

    Due to time constraints, the Office of Legislative Budget Assistant is unable to provide a fiscal note for this bill at this time. When completed, the fiscal note will be forwarded to the House Clerk's Office.