Revision: Feb. 7, 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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.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 FISCAL NOTE
AN ACT relative to long-term care services.
The Department of Health and Human Services and the New Hampshire Association of Counties state this bill, as introduced, may increase state and county revenue and expenditures by an indeterminable amount in FY 2014 and each year thereafter. There will be no impact on local revenue and expenditures.
The Department of Health and Human Services states this bill raises the cost ceiling on community-based care services provided to individuals deemed eligible for Medicaid nursing facility services. Currently, RSA 151-E:11, II states that the average annual cost of services provided to individuals in the mid-level of care shall not exceed 60 percent of the average annual cost for the provision of services in a nursing facility; the average annual cost for home-based care shall not exceed 50 percent of the average annual cost for the provision of services to persons in a nursing facility; and no person whose costs are in excess of 80 percent of the average annual cost for the provision of services to a person in a nursing facility shall be approved for home-based or mid-level services without the prior approval of the commissioner of the Department of Health and Human Services. This bill removes these limits, stating instead that individuals shall have the right to be offered and may choose to receive home or community-based care, provided the cost of such services does not result in greater Medicaid costs to the state and counties than if the individuals were to receive services in a nursing facility.
The Department states it is unable to determine the fiscal impact of this bill, due to unknown variables regarding utilization, point-in-time availability of nursing home beds, and the lack of specific details on the methodology for determining the cost of the proposed adjusted cost ceiling for certain individuals receiving community-based care services. Despite these uncertainties, the Department states there is a strong likelihood that the bill will result in a significant fiscal impact. By raising the cost ceiling on community-based care services, the Department states the bill may result in increased state expenditures, as well as increased revenue in the form of increased federal Medicaid reimbursement. In addition to the impact to the state, the Department anticipates there will likely be a fiscal impact to county and private nursing facilities. The Department states that during FY 2012, there was an average of 2,866 individuals per month receiving community-based care services in New Hampshire. The average annual cost for these individuals was $17,772. During the same time period, the average annual cost for nursing facility services was $52,583.
The New Hampshire Association of Counties states this bill gives individuals the right to choose home or community-based care above the 80 percent threshold currently established in statute. The Association states that, depending on the number of individuals who might choose care above the 80 percent threshold, county expenditures may increase. The Association is unable to determine the number of such cases or to estimate the associated costs. The Association also notes there is a statutory cap on total long-term care Medicaid expenditures by counties and so county expenditures would only increase to the extent the current county-designated cap is not otherwise reached by an individual county. The Association also notes that RSA 151-E:11, II provides a cost threshold on a statewide basis prohibiting average cost for home-based services to exceed 50 percent of the average annual cost for nursing facility services. The Association states it is unclear whether the bill removes this threshold also or whether it removes only the individual 80 percent threshold.