Revision: Jan. 22, 2013, midnight
HB 461-FN – AS INTRODUCED
HOUSE BILL 461-FN
This bill allows individuals eligible to receive Medicaid-funded nursing home services to choose appropriate, community-based services as an alternative, if such community services would not result in greater costs to the state.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Thirteen
AN ACT relative to long-term care services.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Long-Term Care; Purpose. Amend RSA 151-E:1, III to read as follows:
III. This chapter is an essential step toward rebalancing the long-term care system and expanding choices available to recipients. It increases the continuum of care by adding mid-level care, including but not limited to, assisted living and residential care services. Through an acuity-based reimbursement system, a comprehensive needs assessment process, and an information and assistance process, it provides those eligible for Medicaid nursing facility services the [
opportunity] right and ability to choose more appropriate, less costly mid-level services and home and community-based care. In this way, the state intends to serve this increasing Medicaid eligible population more appropriately and more economically and respect the rights of consumers to receive services in the least restrictive setting.
2 New Paragraph; Long-Term Care; Eligibility. Amend RSA 151-E:3 by inserting after paragraph II the following new paragraph:
II-a. Financial eligibility rules in paragraph II, shall include eligibility as medically needy if the person’s countable income is at or below the general Medicaid program medically needy income limit or the person incurs allowable medical expenses each month, including the anticipated cost of waiver services, which exceed the amount of the person’s monthly income which is over the medically needy income limit for the waiver. For the purpose of the waiver, the medically needy income limit shall be the general Medicaid program medically needy income limit plus the difference between that limit and the special income limit for the waiver.
3 Long-Term Care; Consumer Choice. Amend RSA 151-E:4 to read as follows:
151-E:4 Consumer Choice. A person who has been determined to be Medicaid eligible for nursing facility services in accordance with RSA 151-E:3 shall have the right to receive nursing facility services; however, the person shall be offered and may choose to receive services in a less restrictive setting if such services are available and do not result in greater Medicaid costs to the state and counties [
in excess of the limitations set forth in RSA 151-E:11, II] than if the individual chooses to receive services in a nursing facility. In order to facilitate that choice, the individual may utilize the Medicaid funds allocated for his or her nursing facility care to pay for his or her home-based care or his or her mid-level care. Such choice shall be offered in accordance with state laws and federal regulations. The person shall have the right to have his or her individual support plan developed through a person-centered planning process regardless of age, disability, or residential setting. The department shall take into consideration the family and community supports available to the person, the family’s desire and ability to care for the person, and shall ensure that all consideration and support is offered to the family to maintain the person in home and community-based care. Nothing in this section is intended to require the provision of financial assistance or supports by a family member.
4 Assessment or Reassessment at Time of Eligibility. Amend RSA 151-E:8 to read as follows:
151-E:8 Assessment or Reassessment at Time of Eligibility. The department shall perform an assessment or reassessment of the person’s clinical eligibility when the person becomes financially eligible for Medicaid benefits pursuant to RSA 151-E:3, I(b) but no later than 45 days from application for long-term care services.
5 Long-Term Care; Information and Assistance. RSA 151-E:9 is repealed and reenacted to read as follows:
151-E:9 Information and Assistance.
I. The department shall provide information and assistance to each applicant to a nursing facility and shall also provide information and assistance to an individual when the person becomes financially eligible for Medicaid benefits pursuant to RSA 151-E:3, I(b). Such information and assistance shall:
(a) Inform individuals of their right, pursuant to RSA 151-E:4, to choose to receive appropriate services in a less restrictive setting, such as home-based care or mid-level care, if such services are available and do not result in greater costs to the state and counties than if the individual chooses to receive services in a medical facility;
(b) Be based upon the principle that services shall be provided in the setting that is least restrictive of the applicant’s ability to live independently;
(c) Take into consideration the applicant’s choice of service location;
(d) Include information regarding the degree to which the services sought are available at home or in some other community-based setting;
(e) Explain the relative costs to the applicant of choosing care in the home or other setting rather than nursing facility care; and
(f) Include advice relative to whether receiving services in a home or other community-based setting is clinically appropriate for the applicant.
II. The information and assistance under this section shall be provided by the department or its designee. If the department chooses to have a designee or subcontractor provide the information and assistance, the individual providing such services shall not have a financial interest in the nursing facility or be employed by an entity that has a ownership or financial interest in a nursing facility.
6 Long-Term Care; Program Management and Cost Controls. RSA 151-E:11 is repealed and reenacted to read as follows:
151-E:11 Report; Rulemaking.
I. 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.
II. 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 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:
(a) Bases for the methodologies;
(b) Identification of services considered in determining costs;
(c) Average annual costs based on the annual average number of recipients in the setting;
(d) The requirement that nursing facility care include both the initial Medicaid rate and supplemental rates paid through the Medicaid Quality Incentive Program; and
(e) The requirement that the nursing facility will include the cost for transitional case management.
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 or services not provided or reimbursed under Medicaid.
IV. Prior to issuing an eligibility denial due to the cost of care, the department shall provide the applicant or waiver participant the opportunity to review the cost findings with an independent case manager to determine whether a cost reduction is feasible.
7 Effective Date. This act shall take effect 60 days after its passage.
HB 461-FN - FISCAL NOTE
AN ACT relative to long-term care services.
Due to time constraints, the Office of Legislative Budget Assistant is unable to provide a fiscal note for this bill, as introduced, at this time. When completed, the fiscal note will be forwarded to the House Clerk's Office.