Bill Text - HB1816 (2018)

Relative to Medicaid managed care.


Revision: Dec. 14, 2017, 1:50 p.m.

HB 1816-FN - AS INTRODUCED

 

 

2018 SESSION

18-2646

01/03

 

HOUSE BILL 1816-FN

 

AN ACT relative to Medicaid managed care.

 

SPONSORS: Rep. Kurk, Hills. 2

 

COMMITTEE: Health, Human Services and Elderly Affairs

 

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ANALYSIS

 

This bill requires the commissioner of the department of health and human services to adjust the Medicaid managed care program by requesting a certain waiver from the Centers for Medicare and Medicaid Services, implementing enhanced eligibility screening, and requiring managed care organizations to meet the federal medical loss ratio provision with any surplus to be deposited into the general fund.  This bill also eliminates certain provisons under step 2 of the 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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

18-2646

01/03

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Eighteen

 

AN ACT relative to Medicaid managed care.

 

Be it Enacted by the Senate and House of Representatives in General Court convened:

 

1  New Subparagraphs; Medicaid  Managed Care Program; Waiver; Eligibility; Medical Loss Ratio.  Amend RSA 126-A:5, XIX by inserting after subparagraph (g) the following new subparagraphs:

(h)  The commissioner shall seek a waiver to allow the general court instead of actuaries to determine the per-member-per-month (PMPM) rate for managed care organizations.  Prior to submitting the waiver to CMS, the commissioner shall present the waiver to the fiscal committee of the general court for approval.

(i)  The commissioner shall develop and implement enhanced eligibility screening to stop payments in a timely manner to those persons who are no longer eligible.

(j)  The commissioner shall require managed care organizations to meet the federal medical loss ratio.  Any surplus funds accumulated under this subparagraph shall be deposited in the general fund.

(k)  Notwithstanding any provision of law to the contrary, the remaining unimplemented phases of the Medicaid managed care program, established in this paragraph, specifically nursing facility services and services provided under the choices for independent waiver, issued by the Centers for Medicare and Medicaid Services under 42 U.S.C. section 1396(c), shall not be implemented.

2  Effective Date.

I.  RSA 126-A:5, XIX(k) as inserted by section 1 of this act shall take effect upon its passage.

II.  The remainder of this act shall take effect 60 days after its passage.

 

LBAO

18-2646

12/14/17

 

HB 1816-FN- FISCAL NOTE

AS INTRODUCED

 

AN ACT relative to Medicaid managed care.

 

FISCAL IMPACT:      [ X ] State              [ X ] County               [    ] Local              [    ] None

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2019

FY 2020

FY 2021

FY 2022

   Appropriation

$0

$0

$0

$0

   Revenue

Indeterminable

Indeterminable

Indeterminable

Indeterminable

   Expenditures

Indeterminable

Indeterminable

Indeterminable

Indeterminable

Funding Source:

  [ X ] General            [    ] Education            [    ] Highway           [ X ] Other - Federal matching funds

 

METHODOLOGY:

This bill makes a variety of changes to RSA 126-A:5, which governs the state's Medicaid managed care program.  In particular, the bill: (1) directs the Department of Health and Human Services to seek a federal waiver allowing the General Court instead of actuaries to determine the per-member-per-month (PMPM) rate paid to managed care organizations (MCO); (2) directs the Department to develop and implement an enhanced screening tool to quickly stop payments to those no longer eligible, (3) requires MCOs to meet the medical loss ratio, with any surplus funds deposited in the State General Fund; and (4) directs that unimplemented phases of the Medicaid managed care program, specifically nursing facility and Choices for Independence services, not be implemented.

 

With respect to (1), the Department of Health and Human Services states the federal Centers for Medicare and Medicaid Services (CMS) is unlikely to approve any waiver transferring authority to set capitated rates to the General Court.  With respect to (2), the Department projects an indeterminable cost increase related to the development and implementation of enhanced eligibility screening.  The Department is unable to predict the extent of any cost savings that might result from the development of such a system.  With respect to (3), the Department notes the following: the federal Medicaid managed care rule establishes a minimum medical loss ratio of 85% for MCOs, but permits states to mandate medical loss ratios higher than the 85%.  The loss ratio contained in the current MCO contracts is 89.3%.  Unlike this bill, the federal rule does not require remittances from MCOs that fail to meet the minimum standard, although states do have the authority to require such remittances.  The Department assumes the amount of remittance deposited in the General Fund as a result of this bill would be the State's share (50% in the case of the traditional Medicaid program) and not the entire amount remitted.  The Department is unable to determine the extent of any General Fund benefit due to this component of the bill.  Finally, with respect to (4), the Department states it is unable to determine the fiscal impact at the state/county/local level of not implementing the final phases of Medicaid managed care.

 

The New Hampshire Association of Counties states this bill will have no impact on county revenues or expenditures.

 

AGENCIES CONTACTED:

Department of Health and Human Services and New Hampshire Association of Counties