Revision: Feb. 17, 2017, 9:26 a.m.
SB 235-FN - AS INTRODUCED
2017 SESSION
17-0764
05/04
SENATE BILL 235-FN
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
-----------------------------------------------------------------
I. Provides that the Medicaid to schools program may be used for reimbursement of services provided to children with medical needs, rather than children with disabilities.
II. Directs the department of health and human services to establish a Medicaid home and community based behavioral health services program for children with severe emotional disturbances.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
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 and establishing a home and community based behavioral health services program for children.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Medicaid to Schools Program. Amend RSA 186-C:25, I and II to read as follows:
I. There is established within the department of health and human services a Medicaid reimbursement program to be known as the "Medicaid to schools'' program providing medical assistance for covered services furnished to children with disabilities. The purpose of the program is to seek Medicaid reimbursement for services provided by local school districts and school administrative units to children [with disabilities] which are reimbursable under federal law but which [were previously] would otherwise be fully funded by such districts or administrative units. The program shall be voluntary and is designed to assist children with [disabilities] medical needs by maintaining them in their own homes and communities. [This subdivision is intended to provide Medicaid funding for services which, in the absence of such funding, nevertheless qualify as special education or related services under this chapter.] It is not the intention of this subdivision to increase school district responsibility or liability beyond what is required by other sections of this chapter.
II. Eligible services [may be provided to children with disabilities and] may include, but shall not be limited to, the following:
(a) Screening, evaluation, and diagnostic services.
(b) Speech pathology and audiology.
(c) Occupational and physical therapy.
(d) Any other service which qualifies [as a special education or related service under RSA 186-C or federal law and which also qualifies] for reimbursement under Medicaid as a covered service.
2 Medicaid to Schools Program. Amend RSA 186-C:25, VI to read as follows:
VI. New Hampshire local school districts, [or] school administrative units, or their contractors shall be the enrolled Medicaid providers for the purpose of administration and billing.
3 Medicaid-Funded Services. Amend RSA 186-C:29, I to read as follows:
I. [Medicaid-funded services that are provided as part of a child's individualized education program (IEP) shall be provided for the sole purpose of enabling the child to benefit from special education or to receive a free and appropriate public education.] If a child receives Medicaid-funded services as part of the child's special education program and also receives the same or similar medical services outside of his or her special education program, the services that are provided outside of the child's special education program shall not be considered to be duplicative provided such services are medically necessary and not inconsistent with federal Medicaid law. Medicaid-funded services that are provided as part of a child's individualized education program shall not be considered to be duplicative services if the child receives the same or similar medical services outside of his or her special education program, provided both services are medically necessary and not inconsistent with federal Medicaid law.
4 New Section; Public Assistance; Home and Community Based Behavioral Health Services Program. Amend RSA 167 by inserting after section 3-j the following new section:
167:3-k Home and Community Based Behavioral Health Services for Children. The department shall establish a Medicaid home and community based behavioral health services program for children with severe emotional disturbances whose service needs cannot be met through traditional behavioral health services. The department may establish such services through a state plan amendment as provided in Section 1915(i) of the Social Security Act or a waiver under other provisions of the Act. If the department proceeds with a waiver, it shall not limit the geographic availability of services. Such services shall include the following services or their functional equivalent:
I. Wraparound care coordination.
II. Wraparound participation.
III. In home respite care.
IV. Out of home respite care.
V. Customizable goods and services.
VI. Family peer support.
VII. Youth peer support.
5 Department of Health and Human Services; Rulemaking. The department of health and human services shall initiate any rulemaking required to bring existing administrative rules into conformity with sections 1 and 2 of this act no later than September 1, 2017.
6 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
|
| |||
| 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 | |||
|
|
|
|
|
LOCAL: |
|
|
|
|
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