SB 289-FN - AS AMENDED BY THE SENATE
SENATE BILL 289-FN
SPONSORS: Sen. Fuller Clark, Dist 21; Rep. Knirk, Carr. 3
COMMITTEE: Health and Human Services
I. Requires collection stations, not just those operated by laboratories, to be licenses under RSA 151 and revises the responsibilities of an individual home care service provider to include health support services.
II. Authorizes reimbursement for a legally responsible relative who provides personal care services under RSA 161-I.
III. Requires services provided to individuals with disabilities by area agencies and authorized agencies to comply with RSA 171-A and the federal requirements for the home and community based care waiver.
IV. Requires that home-based long-term care services provided under RSA 151-E comply with the federal requirements for the home and community-based care waiver.
V. Provides that the committee for the protection of human subjects shall defer to the institutional review board designated by the federal agency responsible for funding in certain cases.
VI. Clarifies the authority of pharmacies to dispense prescription drugs and removes the requirement that the protocol and criteria for dispensing drugs be approved by the department of health and human services.
VII. Revises the medical support obligation for purposes of determining parental rights and responsibilities and child support to mean the obligation to provide health care coverage for a dependent child whether in the form of private health insurance or public health care.
The bill is a request of the department of health and human services.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/07/2019 0637s 19-0858
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Nineteen
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Residential Care and Health Facility Licensing; License Required. Amend RSA 151:2, I(c) to read as follows:
(c) Laboratories performing tests or analyses of human samples, collection stations [operated by laboratories], or laboratories performing testing on therapeutic cannabis pursuant to RSA 126-X:6, III(a)(16).
2 Residential Care and Health Facility Licensing; Individual Home Care Service Provider. Amend RSA 151:2-b, V to read as follows:
V. "Individual home care service provider" means any individual not employed by a home health care provider licensed under RSA 151:2, I(b) who solicits and provides health support services, personal care services, or homemaker services for compensation to clients in their places of residence; provided that the client is not a family member.
161-I:3-a Authorization of Legally Responsible Relative. The department may authorize reimbursement to a [parent] legally responsible relative who provides personal care to [a minor child] an eligible consumer with special health care needs residing at home. Such reimbursement shall occur only when the department determines that the needs of the [child] eligible consumer, the unavailability of appropriate providers or suitable alternative care services, and cost efficiencies make utilization of a [parent] legally responsible relative for the provision of such services necessary and appropriate. Reimbursement shall be limited to care that is medically necessary due to specific health needs and shall not be made for care generally expected and provided by [parents to a child of similar age and developmental stage] a legally responsible relative. The department shall not authorize reimbursement to a [parent] legally responsible relative until a plan and rules adopted pursuant to RSA 541-A, are reviewed and approved by the oversight committee on health and human services, established in RSA 126-A:13.
I-b. "Area agency" means an entity established as a nonprofit corporation in the state of New Hampshire which is established by rules adopted by the commissioner to provide and/or coordinate services to developmentally disabled persons in the area.
I-e. "Authorized agency" means an entity providing direct service to developmentally disabled persons, including, but not limited to, community living arrangements, employment and day services, and programs designed to enhance personal and social competence.
I. There shall be an individual service agreement for every client in the service delivery system who receives services. A service coordinator [designated by the area agency serving] chosen by the client shall develop a preliminary written individual service agreement based upon a comprehensive screening evaluation established under RSA 171-A:6 for such client within 14 days after the initial service planning meeting. The individual service agreement shall be continually reviewed by the area agency and shall be modified if necessary. The commissioner shall adopt rules pursuant to RSA 541-A relative to the development of such individual service agreements.
I. The commissioner may designate by rules adopted pursuant to RSA 541-A for each area one area agency which shall be responsible for administering area-wide programs and services for developmentally disabled persons. Each area agency so designated shall be the primary recipient of funds that may be dispensed by the commissioner for use in establishing, operating, and/or administering such programs and services. The programs and services for which an area agency is responsible include, but are not limited to, diagnosis and evaluation, service coordination, community living arrangements, employment and day services, and programs designed to enhance personal and social competence.
II. The commissioner may enter into contracts with, make grants to, or otherwise make funds available to [each] an area agency or authorized agency for the provision of programs and services to developmentally disabled persons. Subject to the written approval of the commissioner, an area agency or authorized agency may enter into contracts with individuals or organizations for the expenditure of portions of such funds on programs or services for developmentally disabled persons. Area agencies, authorized agencies, and other organizations under contract to provide services in accordance with this chapter shall administer programs and services in accordance with 42 C.F.R. section 441.301, and any subsequent amendments thereto.
III. Each area board shall appoint an executive director who shall be accountable to the board for administering the area-wide programs and services for developmentally disabled persons. The executive director shall serve at the pleasure of the area board and shall serve as a full-time employee of the area board.
IV. The commissioner shall, in accordance with RSA 541-A, adopt rules establishing standards for the provision of services by area agencies and authorized agencies to developmentally disabled persons. The commissioner shall further adopt rules establishing standards relating to the professional qualifications of the executive director of the area board and to the size and composition of area boards in order to assure that membership is representative of the area as a whole and reflects the concerns and interests of developmentally disabled persons and their families. The commissioner shall also adopt rules establishing a reapproval process and shall require area agencies to be subject to reapproval every 5 years.
151-E:4 Consumer Choice.
I. A person who has been determined to be Medicaid eligible for nursing facility services in accordance with RSA 151-E:3 shall have the right to receive nursing facility services; however, the person shall be offered and may choose to receive services in a less restrictive setting if such services are available and do not result in costs to the state and counties in excess of the limitations set forth in RSA 151-E:11, II. Such choice shall be offered in accordance with state laws and federal regulations. The person shall have the right to have his or her individual support plan developed through a person-centered planning process regardless of age, disability, or residential setting. The department shall take into consideration the family and community supports available to the person, the family's desire and ability to care for the person, and shall ensure that all consideration and support is offered to the family to maintain the person in home and community-based care. Nothing in this section is intended to require the provision of financial assistance or supports by a family member.
II. All individuals, entities, or organizations under contract to provide services in accordance with this chapter shall administer programs and services in accordance with 42 C.F.R. section 441.301, and any subsequent amendments thereto.
151-E:5 Information and Referral. The department shall establish a system of community-based information and referral resource centers that may provide oversight of care, in addition to information and referral services to elderly and chronically ill adults. The information and referral network established under this section shall not be used for the purpose of political advocacy, but may inform and educate the general court regarding the extent of services available as well as the unmet needs in the community.
10 Rulemaking. The department of health and human services shall enter into rulemaking to amend existing administrative rules to align with changes to RSA 171-A and RSA 151-E made in sections 4-9 of this act.
I. There is hereby established within the department an institutional review board which shall be known as the committee for the protection of human subjects. The committee shall oversee research conducted in department-funded programs that serve people with mental illness, developmental disabilities, and substance abuse or dependence disorders. No research shall be conducted in these programs until it has been reviewed and approved by the committee. In matters of cooperative research involving more than one institution, if the federal agency funding the research determines that a single institutional review board will provide oversight, the committee shall defer oversight to that institutional review board.
VII. The dispensing of noncontrolled prescription drugs [by registered nurses in clinics operated by or under contract with the department of health and human services] at a clinic by a licensed health professional legally authorized to administer immunizations or dispense mediations, or by [such] registered nurses in clinics of nonprofit family planning agencies under contract with the department of health and human services, provided that:
(a) The drugs are dispensed under a written protocol established by a licensed physician, physician assistant, or by an advanced practice registered nurse, [and approved by the department of health and human services] which provides for responsible supervision over the activities in question and mentions the name of each [registered nurse] health care provider for whom the physician, physician assistant, or advanced practice registered nurse is assuming supervisory responsibility. A written and signed copy of the protocol showing the date it was approved [by the department of health and human services] shall be kept at the clinic at all times and shall be made available during any inspection conducted under RSA 318:8.
(b) The drugs appear on the current vaccine schedule recommended by the federal advisory committee on immunization practices or the current formulary approved pursuant to RSA 326-B.
(c) The drugs are dispensed or administered only to bona fide clients of the clinic for their personal needs pursuant to written eligibility criteria established by [the department of health and human services] the licensed physician, physician assistant, or advanced practice registered nurse who established the written and signed protocol.
(d) [The clinic, except for clinics operated directly by the department of health and human services, possesses a current limited retail drug distributor's license under RSA 318:51-b.] Nothing in this section shall be construed to negate any authority of the board of pharmacy pursuant to RSA 318:8.
IV-a. "Medical support obligation" means the obligation of either or both parents to provide [health insurance] health care coverage for a dependent child, whether in the form of private health insurance or public health care, and/or to pay a monetary sum toward the cost of [health insurance] health care coverage provided by a public entity, parent, or other person.
(A) Whether, in cases of equal or approximately equal residential responsibility, the parties have agreed to the specific apportionment of variable expenses for the children, including but not limited to education, school supplies, day care, after school, vacation and summer care, extracurricular activities, clothing, health [insurance] care coverage costs and uninsured health care costs, and other child-related expenses.
IX.(a) Each child support order shall include the court's determination and findings relative to [health insurance] health care coverage, whether in the form of private health insurance or public health care, and the payment of uninsured medical expenses for the child. Health care coverage includes fee for service, health maintenance organization, preferred member organization, and other types of private health insurance and public health care coverage under which medical services could be provided to the dependent child.
(b) The court shall determine whether private [health insurance] health care coverage is accessible and is available to either parent at a cost that is at or below the reasonable medical support obligation amount, as established and ordered pursuant to RSA 458-C:3, V, or is available by combining the reasonable medical support obligations of both parents, and, if so available, the court shall order the parent, or parents, to provide such insurance for the child. The cost of providing private [health insurance] health care coverage is the cost of adding the child to existing coverage, or the difference between individual and family coverage. Accessible [health insurance] health care coverage means the primary care services are located within 50 miles or one hour from the child's primary residence.
(c) If the court determines that private [health insurance] health care coverage is not accessible or available at a cost that is at or below the reasonable medical support obligation amount, the court shall establish a cash medical support obligation for either or both parents, equal to the reasonable medical support obligation amount, and order that either or both parents shall obtain such private [health insurance] health care coverage if it subsequently becomes accessible and available at a cost that is at or below the reasonable medical support obligation amount. When ordered in lieu of private [health insurance] health care coverage, an obligation for cash medical support shall be suspended and shall not accrue during such time as the obligated parent is providing private [health insurance] health care coverage in accordance with this paragraph.
(d) In all cases where support is payable through the department, or where the department is providing medical assistance for the child under RSA 167, the court shall include the medical support obligation in any order issued on or after the effective date of this paragraph.
(e) A court may order either or both parents to pay a medical support obligation, either to provide health [insurance] care coverage or as cash medical support, in excess of the reasonable medical support obligation amount, in such other circumstances, as the court deems appropriate.
X. If both parents have [coverage which provides medical insurance benefits] private health insurance for the child, the insurance of the person who is obligated by court order to provide [medical insurance] health care coverage shall be the primary coverage for the child. This paragraph shall not affect the obligation of the insurance carrier of the parent who is not obligated to provide [medical insurance] health care coverage for the child to provide medical insurance benefits for any claim under a policy held by such parent.
XI. All support orders issued or modified in cases that are payable through the department shall contain a provision requiring the obligor to keep the department informed of the name and address of the obligor's employer and whether the obligor has access to health [insurance] care coverage, and, if so, the health [insurance] care policy or program information as requested by the department.
I. Sections 1-2 of this act shall take effect 60 days after its passage.
II. Sections 3-10 of this act shall take effect July 1, 2019.
III. The remainder of this act shall take effect upon its passage.
SB 289-FN- FISCAL NOTE
FISCAL IMPACT: [ X ] State [ ] County [ ] Local [ ] None
Estimated Increase / (Decrease)
[ X ] General [ ] Education [ ] Highway [ X ] Other - Federal funds
(1) requires collection stations to be licensed under RSA 151, and revises the responsibilities of individual home care service providers;
(2) authorizes reimbursement for legally responsible relatives who provide personal care services;
(3) requires services provided to individuals with disabilities to comply with RSA 171-A and federal requirements for the home- and community-based care waiver;
(4) requires that home-based long-term care services provided under RSA 151-E comply with federal requirements for the home- and community-based care waiver;
(5) clarifies the authority of pharmacies to dispense prescription drugs and removes the requirement that the protocol and criteria for dispensing drugs be approved by the Department of Health and Human Services; and
(6) revises the medical support obligation for purposes of determining parental rights and responsibilities.
With respect to (1), the Department states the proposed changes will result in the need for additional clinical life and safety inspections, resulting in increased payroll costs. While the Department is unable to project the extent of any such increase, it notes that in the current environment, inspections cost $286,134 in general funds in FY17. Any increased costs as a result of this bill will be offset in part by additional revenue in the form of fees and fines paid by licensed entities.
The Department states that (2) will have no fiscal impact.
With respect to (3) and (4), the Department states that initially, the proposed changes will have no fiscal impact, as compliance with federal regulations is not required until August 2021 and March 2022, respectively. Any fiscal impact would therefore not occur until FY 2022. At that point, noncompliance with federal regulations would jeopardize federal funding for the various programs; currently, federal funding for the programs totals approximately $175 million per year.
The Department did not provide information on the fiscal impact, if any, of (5).
The Department does not anticipate (6) resulting in any fiscal impact. The proposed changes consist of definitional clarification necessary to bring statute into alignment with federal regulations.
Department of Health and Human Services
|Jan. 3, 2019||Introduced 01/03/2019 and Referred to Health and Human Services; SJ 4|
|Feb. 5, 2019||Hearing: 02/05/2019, Room 101, LOB, 01:45 pm; SC 9|
|March 7, 2019||Committee Report: Ought to Pass with Amendment # 2019-0637s, 03/07/2019; SC 12|
|March 7, 2019||Committee Amendment # 2019-0637s, AA, VV; 03/07/2019; SJ 7|
|March 7, 2019||Ought to Pass with Amendment 2019-0637s, MA, VV; Refer to Finance Rule 4-5; 03/07/2019; SJ 7|
|March 21, 2019||Committee Report: Ought to Pass, 03/21/2019; SC 14|
|Feb. 5, 2019||Senate||Hearing|
|March 7, 2019||Senate||Floor Vote|
|March 21, 2019||Senate||Floor Vote|