Revision: Jan. 13, 2016, midnight
\t \t\tSB 491-FN - AS INTRODUCED
2016 SESSION
\t16-2940
\t01/09
SENATE BILL\t491-FN
AN ACT\trelative to Medicaid home health care services.
SPONSORS:\tSen. Hosmer, Dist 7; Sen. Kelly, Dist 10; Sen. Boutin, Dist 16; Sen. Watters, Dist 4; Sen. Little, Dist 8; Sen. D'Allesandro, Dist 20; Sen. Stiles, Dist 24
COMMITTEE:\tHealth and Human Services
-----------------------------------------------------------------
ANALYSIS
\tThis bill requires Medicaid coverage of medically-necessary home health care services to be provided to older adults and persons with disabilities in their residences and the community.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Explanation:\tMatter added to current law appears in bold italics.
\t\tMatter removed from current law appears [in brackets and struckthrough.]
\t\tMatter which is either (a) all new or (b) repealed and reenacted appears in regular type.
\t16-2940
\t01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Sixteen
AN ACT\trelative to Medicaid home health care services.
Be it Enacted by the Senate and House of Representatives in General Court convened:
\t1 New Chapter; Home Health Care Agency Services. Amend RSA by inserting after chapter 161-M the following new chapter:
CHAPTER 161-N
Home Health Care Agency Services
\t161-N:1 Purpose. Older adults and people with disabilities, including children with special health care needs, require the support of home health care services. The purpose of this chapter is to ensure medically-necessary home health care services are available to Medicaid recipients in their residences and in non-institutional locations outside of the residence in which normal life activities take place.
\t161-N:2 Definitions.
\t\tI. "Commissioner" means the commissioner of the department of health and human services.
\t\tII. "Home health care services" means care provided by a medical provider licensed under RSA 326-B and employed by a home health care agency licensed under RSA 151, when that care is provided in the residence of the recipient or in a non-institutional setting where normal life activities take place. The residence of the recipient shall not include a hospital, a nursing facility, or an intermediate care facility for individuals with intellectual disabilities, except for home health care services in an intermediate care facility for individuals with intellectual disabilities that are not required to be provided by the facility.
\t161-N:3 Home Health Care Services Location.
\t\tI. Medicaid coverage of medically-necessary home health care services shall be available to Medicaid recipients in their residences and in any non-institutional setting in which normal life activities take place.
\t\tII. The commissioner may develop and prepare any necessary amendments to the state Medicaid plan or waiver for submission to the Centers for Medicare and Medicaid Services for federal approval necessary to implement the provisions of this chapter.
\t161-N:4 Rulemaking. The commissioner shall adopt rules, pursuant to RSA 541-A, relative to:
\t\tI. Further definition of home health care services which may be included under this chapter.
\t\tII. Content and format of forms required under this chapter.
\t\tIII. Any other matter necessary to the proper administration of this chapter.
\t2 Effective Date. This act shall take effect upon its passage.
\t\t\t\t\t\t\t\t\t\t\t16-2940
\t\t\t\t\t\t\t\t\t\t\t1/5/16
SB 491-FN- FISCAL NOTE
AN ACT\trelative to Medicaid home health care services.
FISCAL IMPACT:
The Department of Health and Human Services states this bill, as introduced, will have an indeterminable impact on state general fund expenditures in FY 2017 and each year thereafter. There will be no impact on county and local expenditures, or on state, county, and local revenue.
METHODOLOGY:
The Department of Health and Human Services states this bill allows medically necessary home health services to be made available to Medicaid recipients in non-institutional settings in which normal life activities take place. The bill further authorizes the commissioner to develop a Medicaid state plan amendment necessary to implement the bill's provisions.
The Department notes that under Title XIX of the federal Social Security Act, states must offer certain services to categorically needy populations in order to receive federal matching funds. Home health care services for Medicaid-eligible individuals comprise one such category of mandatory services, and include skilled nursing services, home health aide services, and medical supplies, as well as physical therapy, occupational therapy, speech therapy, and audiology services when provided by a home health agency licensed under state law to provide rehabilitative services. Currently, federal rules require these services be provided at the place of residence. In July of 2011, the federal Centers for Medicare and Medicaid Services (CMS) issued a notice of proposed rulemaking (NPRM) to expand the locations at which home health services may be performed. Specifically, the NPRM stated CMS was revising the definition of "residence" to include the following language: "Nothing in this section should be read to prohibit a recipient from receiving home health services in any non-institutional setting in which normal life activities take place. Additional services or service hours may, at the State's option, be authorized to account for medical needs that arise in these settings." To date, CMS has neither adopted the NPRM nor issued a formal statement saying when the rule will be issued and adopted in its final form.
As noted above, the proposed bill permits the Department to submit a state plan amendment to CMS to obtain the necessary approval to implement the bill's provisions. The Department assumes if it does not receive CMS approval (and assuming CMS does not implement the NPRM described above), it will not be required to implement the bill. Further, the Department assumes compliance with the bill will be pending upon CMS approval of the state plan amendment. The Department notes that currently, home health services are paid 50 percent by general fund dollars and 50 percent by federal matching funds. Assuming the Department receives approval from CMS, the provision of these services at other locations will continue to be paid with 50 percent general fund and 50 percent federal dollars. The Department is unable to calculate the fiscal impact of expanding services to other locations, but notes that in theory, there may be no impact at all because the number of approved hours per Medicaid recipient is based upon the recipient's demonstration the requested hours are medically necessary, and determinations of medical necessity are not dependent upon where services are delivered. Nevertheless, the Department states the practical effect of the proposed bill will be that Medicaid recipients will request additional services, the Department will have to review those requests, and if it denies them, will need to defend its decisions. All of these activities will increase administrative costs by an indeterminable amount.
Finally, with respect to provision of the above-mentioned services, the Department notes that most Medicaid services are provided by Managed Care Organizations (MCO). Expanding the locations for delivery of home health services may have a financial impact to the MCOs in that utilization of these services may increase if the MCOs approve an increase in the number of hours a recipient can receive. Were this to occur, it would necessitate an amendment to the managed care contract, an adjustment to the capitation rate paid to the MCOs, and review and approval by CMS of the managed care contract amendment.
The New Hampshire Association of Counties states this bill will have no fiscal impact.