Revision: May 5, 2017, 9:34 a.m.
SB 235-FN - AS AMENDED BY THE HOUSE
03/30/2017 1106s
03/30/2017 1231s
4May2017... 1421h
2017 SESSION
17-0764
05/04
SENATE BILL 235-FN
AN ACT relative to Medicaid reimbursement to schools for students with medical needs.
SPONSORS: Sen. Reagan, Dist 17; Sen. Avard, Dist 12; Sen. Carson, Dist 14; Sen. French, Dist 7; Sen. Fuller Clark, Dist 21; Sen. Gannon, Dist 23; Sen. Giuda, Dist 2; Sen. Gray, Dist 6; Sen. Innis, Dist 24; Sen. Lasky, Dist 13; Sen. Soucy, Dist 18; Sen. Watters, Dist 4; Rep. Snow, Hills. 42; Rep. Rosenwald, Hills. 30; Rep. Fothergill, Coos 1
COMMITTEE: Health and Human Services
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This bill establishes a Medicaid to schools for medical services program, which allows schools to pay for services provided to children with medical needs, regardless of whether the student receives special education services through an individualized education plan (IEP). The bill also adds a reporting requirement to the existing Medicaid to schools program.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/30/2017 1106s
03/30/2017 1231s
4May2017... 1421h 17-0764
05/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Seventeen
AN ACT relative to Medicaid reimbursement to schools for students with medical needs.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Medicaid to Schools for Medical Services. Amend RSA 167 by inserting after section 3-j the following new section:
167:3-k Medicaid to Schools For Medical Services Program.
I. There is established within the department of health and human services a Medicaid reimbursement program to be known as the "Medicaid to schools for medical services" program providing medical assistance for covered services furnished to children in public schools. The purpose of the program is to seek Medicaid reimbursement for services provided by local school districts and school administrative units to children which are reimbursable under federal law but which would otherwise be fully funded by such districts or administrative units. General fund dollars allocated to the department of health and human services shall not be used for matching the federal financial participation for Medicaid reimbursement. All matching dollars for Medicaid to schools medical services shall come from the local school districts or school administrative units. The program shall be voluntary and administered by the department in the same, or similar, manner as the Medicaid to schools program established in RSA 186-C:25. This section shall not be construed to increase school district responsibility or liability beyond what is required by other state or federal law.
II. Eligible services may be provided to Medicaid-eligible children and may include services defined through rulemaking pursuant to paragraph IV under the following conditions:
(a) The service is a covered Medicaid service, provided in accordance with the approved state plan methodologies, including coverage under the Early and Periodic Screening Diagnostic and Treatment benefit provided to children.
(b) The provider is a Medicaid-participating provider and meets all federal and state provider qualification requirements.
(c) The state plan contains a payment methodology for determining rates that are consistent with efficiency, economy, and quality of care.
(d) Third party liability requirements are met.
(e) Medicaid payment does not duplicate other specific payments for the same service.
(f) The state and provider maintain auditable documentation to support claims for federal financial participation (FFP).
(g) The state conducts appropriate financial oversight of provider billing practices.
(h) All other federal and state program requirements for the service, payment, and associated claiming are met.
III. Services provided under this section shall:
(a) Be provided to children in conformity with any medical criteria necessary for Medicaid reimbursement.
(b) Be provided only after obtaining informed parental consent.
IV. The commissioner of the department of health and human services, after consultation with the commissioner of the department of education, shall adopt rules, pursuant to RSA 541-A, relative to:
(a) Further defining services eligible for Medicaid reimbursement under this section. In defining such services, the commissioner shall, to the extent practicable, seek to maximize the availability of federal financial assistance to local school districts and school administrative units.
(b) State plans and reimbursement procedures necessary for local school districts or school administrative units to receive appropriate Medicaid reimbursement for eligible services under paragraph II that are provided or paid for by school districts or school administrative units.
(c) Monitoring mechanisms to ensure that services provided under this section meet the requirements of paragraph III. Monitoring responsibilities shall be consistent with the jurisdiction of the different departments.
(d) A financial mechanism by which the federal mandatory matching requirement is met through collection, or other means, of 50 percent of the cost of allowable services from local school districts and/or school administrative units.
V. Billing for services in accordance with this section shall not commence until the administrative rulemaking procedure required under paragraph IV is complete and shall be for services provided on or after the effective date of such rules.
VI. New Hampshire local school districts or school administrative units shall be the enrolled Medicaid providers for the purpose of administration and billing.
2 New Paragraph; Medicaid to Schools Program. Amend RSA 186-C:25 by inserting after paragraph VI the following new paragraph:
VII. Beginning on September 1, 2018, the commissioner of the department of health and human services shall submit an annual report to the senate president, the speaker of the house of representatives, and the chairpersons of the house and senate finance committees regarding the total cost of the Medicaid to schools program and the number of students who received services through the program during the prior school year.
3 Department of Health and Human Services; Rulemaking. The department of health and human services shall initiate the rulemaking required under RSA 167:3-k, as inserted by section 1 of this act, no later than September 1, 2017.
4 Effective Date. This act shall take effect 60 days after its passage.
17-0764
1/30/17
SB 235-FN- FISCAL NOTE
as introduced
FISCAL IMPACT: [ X ] State [ ] County [ X ] Local [ ] None
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| Estimated Increase / (Decrease) | |||
STATE: | FY 2018 | FY 2019 | FY 2020 | FY 2021 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | $0 | $0 | $0 | $0 |
Expenditures | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ X ] Federal Funds | |||
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LOCAL: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
METHODOLOGY:
This bill allows school districts to use the Medicaid to Schools program to pay for Medicaid-covered services delivered in a school setting, without requiring the recipient of those services to have an Individualized Education Plan (IEP). The Department of Health and Human Services states that currently, under the Medicaid to Schools program, schools provide all services required by a student's IEP and either pay for those services directly, or submit claims through the Department for reimbursement. The reimbursement received by schools is comprised entirely of federal funds; there are no state funds involved, as the non-federal share of costs is borne by the school district. This bill eliminates the requirement that a student have a disability and an IEP in order for a school to obtain Medicaid reimbursement, and provides instead that a school is allowed to seek reimbursement for services provided to children with "medical needs." The Department notes the bill does not define "medical needs." The bill further allows contractors of a local school district to be enrolled Medicaid providers for the purpose of administration and billing. The Department states it is unclear how reimbursement to schools would work in instances in which a contractor is able to bill Medicaid directly; there may be some administrative and technology costs to the state in order to allow for contractors to directly bill for services. Despite this, the Department assumes that reimbursement for the services will continue to be entirely federal, and there will be no program costs to the State as a result of this change. The fiscal impact on school districts is unclear; both the Department of Health and Human Services and the Department of Education note there may be a benefit to school districts if they are able to claim reimbursement for services they were previously providing but for which they were not able to seek federal reimbursement. There may also be a cost to local districts, however, should they provide additional services to students as a result of the change. The Department of Education notes the number of students with medical needs fluctuates with enrollment in any given year, and that the financial impact of the bill is therefore indeterminable.
In addition to the changes described above, the bill requires the Department of Health and Human Services to amend the NH Medicaid State Plan to establish a Medicaid benefit for children with severe emotional disturbances. The Department assumes this means children whose needs cannot be met through traditional behavioral health services, as evidenced by the fact they have had multiple admissions to the NH State Hospital, putting them at risk for out-of-home placement. The Department projects roughly 95 students will meet this criteria each year, and will result in the following costs per individual:
The above services will result in costs of $56,283 per individual, or $5,346,885 annually, of which half ($2,673,443) would be paid for with state general funds and half would be federal funds. The Department notes there may be some cost avoidance as a result of providing these services, in the form of reduced costs associated with juvenile justice involvement and repeat acute psychiatric hospitalizations. Finally, this provision may increase administrative costs to the Department, in the form of technology and staffing requirements needed to determine eligibility, as well as staff time needed to draft and complete the Medicaid State Plan amendment, amendments to State administrative rules, and changes to the contracts with Managed Care Organizations.
AGENCIES CONTACTED:
Departments of Health and Human Services and Education