Revision: June 7, 2016, midnight
\t \t\tSB 491-FN - VERSION ADOPTED BY BOTH BODIES
02/11/2016 0382s
03/24/2016 1067s
06/01/2016 2109EBA
2016 SESSION
\t16-2940
\t01/09
SENATE BILL\t491-FN
AN ACT\trelative to Medicaid home health care services and relative to the scope of practice of licensed nursing assistants.
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
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AMENDED ANALYSIS
\tThis bill requires Medicaid coverage of medically-necessary home health care services to be provided to older adults and persons with disabilities at their residences and in the community. This bill also clarifies the scope of practice of licensed nursing assistants.
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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\t\tMatter which is either (a) all new or (b) repealed and reenacted appears in regular type.
02/11/2016 0382s
03/24/2016 1067s
11May2016... 1593h
06/01/2016 2109EBA
\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 and relative to the scope of practice of licensed nursing assistants.
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 at their residences and in non-institutional locations outside of the residence in which normal life activities take place.
\t161-N:2 Definitions. In this chapter:
\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 home health care agency licensed under RSA 151, when that care is provided at 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. Medicaid coverage of medically-necessary home health care services shall be available to Medicaid recipients at their residences and in any non-institutional setting in which normal life activities take place.
\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 under RSA 161-N:3.
\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 Licensed Nursing Assistant; Scope of Practice. Amend RSA 326-B:14, III(c) to read as follows:
\t\t\t(c) Assist individuals to attain and maintain functional independence [in a home or health care facility].
\t3 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\tAmended 4/8/16
SB 491-FN - FISCAL NOTE
AN ACT\trelative to Medicaid home health care services and relative to the scope of practice of licensed nursing assistants.
FISCAL IMPACT:
The Department of Health and Human Services states this bill, as amended by the Senate (Amendment #2016-0382s and #2016-1067s), will have an indeterminable impact on state general fund expenditures in FY 2017 only. 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 requires 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 on January 27, 2016, the federal Centers for Medicare and Medicaid Services issued a rule 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." This rule is effective July 1, 2017. Because the rule itself allows medically necessary home health services to be made available in non-institutional settings in which normal life activities take place, the Department will no longer need to submit a state plan amendment as contemplated by the bill.
Since the federal rule described above is effective July 1, 2017, any fiscal impact beyond July 1, 2017 will be attributable to the federal rule and not to the bill. The bill, however, is effective upon passage, and so it is reasonable to attribute any costs incurred prior to July 1, 2017 to the bill itself. While the Department is unable to calculate the fiscal impact of expanding services to new locations, it 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 that 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 this change will be 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 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.