Bill Details - SB308 (2019)

SB 308-FN-A - AS AMENDED BY THE SENATE

 

03/14/2019   0870s

2019 SESSION

19-0895

04/01

 

SENATE BILL 308-FN-A

 

AN ACT relative to the health care workforce and making appropriations therefor.

 

SPONSORS: Sen. Rosenwald, Dist 13; Sen. Bradley, Dist 3; Sen. Sherman, Dist 24; Sen. Hennessey, Dist 5; Sen. Cavanaugh, Dist 16; Sen. Feltes, Dist 15; Sen. Fuller Clark, Dist 21; Sen. Kahn, Dist 10; Sen. Levesque, Dist 12; Sen. Morgan, Dist 23; Sen. Soucy, Dist 18; Sen. Watters, Dist 4; Rep. Nordgren, Graf. 12; Rep. Marsh, Carr. 8; Rep. Knirk, Carr. 3; Rep. Danielson, Hills. 7

 

COMMITTEE: Executive Departments and Administration

 

-----------------------------------------------------------------

 

AMENDED ANALYSIS

 

This bill:

 

I.  Increases the Medicaid provider rates.

 

II.  Requires certain health care professionals to complete a survey or an opt-out form for collecting data on the primary care workforce.

 

III.  Requires the department of health and human services to amend the income standard used for eligibility for the "in and out" medical assistance policy.

 

IV.  Permits the department of safety to contract with a private agency to process background check applications, and requires the department to accept and process background check applications online.

 

V.  Amends the definitions and services covered through telemedicine.

 

VI.  Makes appropriations to the department of health and human services, rural health and primary care section to establish new positions and programs to develop and enhance the state's healthcare workforce.

 

VII.  Makes an appropriation to the governor's scholarship program for scholarships to students majoring in a health care field and to postsecondary educational institutions to develop and enhance programs of study offered in health care.

 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

 

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03/14/2019   0870s 19-0895

04/01

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Nineteen

 

AN ACT relative to the health care workforce and making appropriations therefor.

 

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

 

1  Purpose and Findings.  The general court finds that:

I.  New Hampshire’s health care workforce is the foundation of our health care system, but the residents of New Hampshire will go without necessary care if the cracks in the foundation are not repaired.  The state has made great strides through significant investments in the health care infrastructure to increase mental health and substance use disorder treatment capacity and promote integrated care delivery.  These investments, however, do not address one fundamental workforce challenge: New Hampshire does not have the workforce to meet either the current health care needs of our residents or the state’s goal of truly integrating primary care, behavioral health, substance use disorder treatment, and oral health.  New Hampshire’s health care workforce shortage hinders the state’s economic potential, causes a rationing of necessary care, and adds health care costs systemwide.

II.  The state of New Hampshire shall address the health care workforce shortage through programs designed to incent students to seek health care degrees and remain in New Hampshire upon graduation; remove career-advancement barriers for our dedicated direct care providers; and equip health care organizations with the tools necessary to secure skilled clinicians.

III.  It is the intent of the general court to recognize the application of telemedicine for clinically appropriate services and settings, including when such services are delivered from a distant site without in-person contact between the individual and provider.

2  Department of Health and Human Services; Medicaid Provider Rate Increases.  The commissioner of the department of health and human services shall increase all Medicaid provider rates by 5 percent in the fiscal year ending June 30, 2020 and an additional 7 percent in the fiscal year ending June 30, 2021.  The commissioner shall make the necessary adjustments to the medical rate setting data book and direct the actuary and managed care organizations to pass through the increased funding to rates.  Nothing in this section shall be construed to alter the traditional method of establishing the county contribution for Medicaid federal medical assistance percentage.

3  Commissioner of Health and Human Services; State Office of Rural Health.  Amend RSA 126-A:5, XVIII-a(a) to read as follows:

XVIII-a.(a)  The state office of rural health (SORH) established in paragraph XVIII [may] shall receive and collect data regarding surveys completed by participating licensees pursuant to RSA 317-A:12-a, RSA 318:5-b, RSA 326-B:9-a, RSA 328-D:10-a, RSA 328-F:11-a, RSA 329:9-f, RSA 329-B:10-a, RSA 330-A:10-a, and RSA 330-C:9-a.

4  Commissioner of Health and Human Services; State Office of Rural Health.  Amend RSA 126-A:5, XVIII-a(e) to read as follows:

(e)  On or before [November 1, 2017] December 1, 2019, and annually thereafter, the SORH shall make a written report to the speaker of the house of representatives, the senate president, the governor, the oversight committee on health and human services established under RSA 126-A:13, the chairs of the house and senate executive departments and administration committees, the chairs of the house and senate policy committee having jurisdiction over health and human services, and the commission on primary care workforce issues established by RSA 126-T:1.  The report shall include, but not be limited to, aggregate data and information on current and projected primary workforce needs and the participation rate on surveys completed pursuant to this paragraph.  This report shall be incorporated into the report required pursuant to RSA 126-A:5, XVIII(c).

5  Dentists and Dentistry; Examinations and Licensing.  Amend RSA 317-A:12-a to read as follows:

317-A:12-a  Completion of Survey; Rulemaking.  The board [may] shall adopt rules, pursuant to RSA 541-A, requiring, as part of the license renewal process, completion by licensees of a survey or opt-out form provided by the office of rural health, department of health and human services, for the purpose of collecting data regarding the New Hampshire primary care workforce, pursuant to the commission established in RSA 126-T.  Any rules adopted under this section shall provide the licensee with written notice of his or her opportunity to opt-out from participation in the survey.  [Participation in the survey under this section shall not be a condition of licensure.]

6  Pharmacists and Pharmacies; Completion of Survey.  Amend RSA 318:5-b to read as follows:

318:5-b  Completion of Survey; Rulemaking.  The board [may] shall adopt rules, pursuant to RSA 541-A, requiring, as part of the license renewal process, completion by licensees of a survey or opt-out form provided by the office of rural health, department of health and human services, for the purpose of collecting data regarding the New Hampshire primary care workforce, pursuant to the commission established in RSA 126-T.  Any rules adopted under this section shall provide the licensee with written notice of his or her opportunity to opt-out from participation in the survey.  [Participation in the survey under this section shall not be a condition of licensure.]

7  Nurse Practice Act; Completion of Survey.  Amend RSA 326-B:9-a to read as follows:

326-B:9-a  Completion of Survey; Rulemaking.

I.  The board [may] shall adopt rules, pursuant to RSA 541-A, for APRNs only requiring, as part of the license renewal process, completion by licensees of a survey or opt-out form provided by the office of rural health, department of health and human services, for the purpose of collecting data regarding the New Hampshire primary care workforce, pursuant to the commission established in RSA 126-T.  Any rules adopted under this section shall provide the licensee with written notice of his or her opportunity to opt-out from participation in the survey.  [Participation in the survey under this paragraph shall not be a condition of licensure.]

II.  The board [may] shall adopt rules, pursuant to RSA 541-A, for RNs and LPNs only requiring, as part of the license renewal process, completion by licensees of a survey or opt-out form provided by the National Council of State Boards of Nursing regarding minimum data sets.  Any rules adopted under this section shall provide the licensee with written notice of his or her opportunity to opt-out from participation in the survey.  [Participation in the survey under this paragraph shall not be a condition of licensure.]

8  Physician Assistant; Completion of Survey.  Amend RSA 328-D:10-a to read as follows:

328-D:10-a  Completion of Survey; Rulemaking.  The board [may] shall adopt rules, pursuant to RSA 541-A, requiring, as part of the license renewal process, completion by licensees of a survey or opt-out form provided by the office of rural health, department of health and human services, for the purpose of collecting data regarding the New Hampshire primary care workforce, pursuant to the commission established in RSA 126-T.  Any rules adopted under this section shall provide the licensee with written notice of his or her opportunity to opt-out from participation in the survey.  [Participation in the survey under this section shall not be a condition of licensure.]

9  Allied Health Professionals; Completion of Survey.  Amend RSA 328-F:11-a to read as follows:

328-F:11-a  Completion of Survey; Rulemaking.  The board [may] shall adopt rules, pursuant to RSA 541-A, requiring, as part of the license renewal process, completion by licensees of a survey or opt-out form provided by the office of rural health, department of health and human services, for the purpose of collecting data regarding the New Hampshire primary care workforce, pursuant to the commission established in RSA 126-T.  Any rules adopted under this section shall provide the licensee with written notice of his or her opportunity to opt-out from participation in the survey.  [Participation in the survey under this section shall not be a condition of licensure.]

10  Physicians and Surgeons; Completion of Survey.  Amend RSA 329:9-f to read as follows:

329:9-f  Completion of Survey; Rulemaking.  The board [may] shall adopt rules, pursuant to RSA 541-A, requiring, as part of the license renewal process, completion by licensees of a survey or opt-out form provided by the office of rural health, department of health and human services, for the purpose of collecting data regarding the New Hampshire primary care workforce, pursuant to the commission established in RSA 126-T.  Any rules adopted under this section shall provide the licensee with written notice of his or her opportunity to opt-out from participation in the survey.  [Participation in the survey under this section shall not be a condition of licensure.]

11  Psychologists; Completion of Survey.  Amend RSA 329-B:10-a to read as follows:

329-B:10-a  Completion of Survey; Rulemaking.  The board [may] shall adopt rules, pursuant to RSA 541-A, requiring, as part of the license renewal process, completion by licensees of a survey or opt-out form provided by the office of rural health, department of health and human services, for the purpose of collecting data regarding the New Hampshire primary care workforce, pursuant to the commission established in RSA 126-T.  Any rules adopted under this section shall provide the licensee with written notice of his or her opportunity to opt-out from participation in the survey.  [Participation in the survey under this section shall not be a condition of licensure.]

12  Mental Health Practice; Completion of Survey.  Amend RSA 330-A:10-a to read as follows:

330-A:10-a  Completion of Survey; Rulemaking.  The board [may] shall adopt rules, pursuant to RSA 541-A, requiring, as part of the license renewal process, completion by licensees of a survey or opt-out form provided by the office of rural health, department of health and human services, for the purpose of collecting data regarding the New Hampshire primary care workforce, pursuant to the commission established in RSA 126-T.  Any rules adopted under this section shall provide the licensee with written notice of his or her opportunity to opt-out from participation in the survey.  [Participation in the survey under this section shall not be a condition of licensure.]

13  Alcohol and Other Drug Use Professionals; Completion of Survey.  Amend RSA 330-C:9-a to read as follows:

330-C:9-a  Completion of Survey; Rulemaking.  The board [may] shall adopt rules, pursuant to RSA 541-A, requiring, as part of the license renewal process, completion by licensees of a survey or opt-out form provided by the office of rural health, department of health and human services, for the purpose of collecting data regarding the New Hampshire primary care workforce, pursuant to the commission established in RSA 126-T.  Any rules adopted under this section shall provide the licensee with written notice of his or her opportunity to opt-out from participation in the survey.  [Participation in the survey under this section shall not be a condition of licensure.]

14  Department of Health and Human Services; Income Eligibility for "In and Out Medical Assistance."  The commissioner of the department of health and human services shall amend the income eligibility requirement for "in and out medical assistance" defined in section 625 of the department's medical assistance manual as less than or equal to 133 1/3 percent of the section 1931 income limit.

15  State Police; Criminal Records.  Amend RSA 106-B:14, I-b to read as follows:

I-b.  The director shall develop forms and procedures to allow for the online application and processing of criminal record information.  The director shall not require a paper application or notarization on any paper or online form prior to the release of any criminal record information authorized under paragraph I.  The division shall process and report the results of an online request for criminal record information within 48 hours of receipt of the online request.  

I-c.  Any person violating the provisions of this section or any rules adopted under RSA 541-A, shall be guilty of a misdemeanor for each offense.

16  Medicaid Coverage of Telehealth Services.  RSA 167:4-d is repealed and reenacted to read as follows:

167:4-d  Medicaid Coverage of Telehealth Services.

I.  It is the intent of this section to recognize the application of telehealth for covered services provided within the scope of practice of a physician or other health care provider as a method of delivery of medical care by which an individual at an originating site shall receive medical services which are clinically appropriate for delivery through telehealth from a health care provider at a distant site without in-person contact with the provider.

II.  In this section:

(a)  "Telehealth services" shall have the same meaning as 42 C.F.R. section 410.78, except for 42 C.F.R. section 410.78(b)(4).  The use of the term "telemedicine" shall comply with the Centers for Medicare and Medicaid Services requirements governing the aforementioned telehealth services.

(b)  “Distant site” means the location of the health care provider delivering services through telemedicine at the time the services are provided.

(c)  "Originating site" means the location of the patient, whether or not accompanied by a health care provider, at the time services are provided by a health care provider through telemedicine, including, but not limited to, a health care provider's office, a hospital, or a health care facility, or the patient's home or another nonmedical environment such as a school-based health center, a university-based health center, or the patient's workplace.

(d)  "Remote patient monitoring” means the use of electronic technology to remotely monitor a patient's health status through the collection and interpretation of clinical data while the patient remains at an originating site.  Remote patient monitoring may or may not take place in real time.

(e)  “Store and forward,” as it pertains to telemedicine, and as an exception to 42 C.F.R. section 410.78, means the use of asynchronous electronic communications between a patient at an originating site and a health care service provider at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients.  This includes the forwarding and or transfer of stored medical data from the originating site to the distant site through the use of any electronic device that records data in its own storage and forwards its data to the distant site via telecommunication for the purpose of diagnostic and therapeutic assistance.

III.(a) Coverage under this section shall include the use of telehealth or telemedicine for Medicaid-covered services provided within the scope of practice of a physician or non-physician practitioner as a method of delivery of medical care:

(1)  Which is an appropriate application of telehealth services provided by physicians and non-physician practitioners, as determined by the department based on the Centers for Medicare and Medicaid Services regulations, with the exception of also including providers as referenced in Administrative Rules He-M 426.08 and 426.09;

(2)  By which telemedicine services for primary care, remote patient monitoring and substance use disorder services shall only be covered in the event that the patient has already established care at an originating site via face-to-face in-person service; and

(3)  By which an individual shall receive medical services from a physician or non-physician practitioner who is an enrolled Medicaid provider without in-person contact with that provider.

(b)  Nothing in this section shall be construed to prohibit the Medicaid program from providing coverage for only those services that are medically necessary and subject to all other terms and conditions of the coverage.

IV.  This section shall be conditioned upon review and approval of a state plan amendment submitted by the department to the Centers for Medicare and Medicaid Services.

V.  The department shall adopt rules, pursuant to RSA 541-A, necessary to carry out the purposes of this section.

17  New Subparagraph; Rulemaking.  Amend RSA 167:3-c by inserting after subparagraph XIV the following new subparagraph:

XV.  Telehealth services under RSA 167:4-d.

18  New Paragraphs; New Hampshire Telemedicine Act.  Amend RSA 415-J:2 by inserting after paragraph II-a the following new paragraphs:

II-b.  "Remote patient monitoring” means the use of electronic technology to remotely monitor a patient's health status through the collection and interpretation of clinical data while the patient remains at an originating site.  Remote patient monitoring may or may not take place in real time.

II-c.  “Store and forward,” as it pertains to telemedicine, means the use of asynchronous electronic communications between a patient at an originating site and a health care service provider at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients.  This includes the forwarding and or transfer of stored medical data from the originating site to the distant site through the use of any electronic device that records data in its own storage and forwards its data to the distant site via telecommunication for the purpose of diagnostic and therapeutic assistance.

19  New Hampshire Telemedicine Act; Coverage for Telemedicine Services.  Amend RSA 415-J:3, I to read as follows:

I.  It is the intent of the general court to recognize the application of telemedicine for covered services provided within the scope of practice of a physician or other health care provider as a method of delivery of medical care by which an individual at an originating site shall receive medical services which are clinically appropriate for delivery through telemedicine from a health care provider at a distant site without in-person contact with the provider.  For the purposes of this chapter, covered services include remote patient monitoring and store and forward.

20  Department of Health and Human Services; Rural Health and Primary Care Section; Positions and Programs Established.

I.  The department of health and human services, bureau of public health services, rural health and primary care section shall, within 90 days of the effective date of this section, issue a request for proposals to contract with an organization to establish programs designed to improve care and access to care, particularly in rural and underserved areas of this state, and to enhance the health and public health workforce in New Hampshire.  Such programs may include engaging under-represented populations in the health care professions in middle school and high school, offering health professions students opportunities to experience learning in rural or medically underserved regions of New Hampshire designed to encourage participants to settle and work in these regions, and enriching the standard health curriculum by providing health professions students training in aspects of health care such as integration of behavioral health and primary care, social determinants of health, cultural competency, interprofessional team-based care, and addressing the challenges associated with substance misuse.

II.  There is established within the department of health and human services, division of public health services, rural health and primary care section, 2 full-time, unclassified positions.  The salary for such positions shall be as set forth in RSA 94:1-a, provided that the salary for such positions shall be determined after assessment and review of the appropriate temporary letter grade allocation in RSA 94:1-a, I(b) for the positions which shall be conducted pursuant to RSA 94:1-d and RSA 14:14-c.

III.  The department of health and human services, division of public health services, rural health and primary care section shall, within 90 days of the effective date of this section, issue a request for proposals to retain the services of an organization specializing in the recruitment and retention of clinicians in medically underserved areas for the purpose of creating a national outreach campaign designed to recruit qualified clinicians to New Hampshire.

IV.  The department of health and human services, division of public health services, rural health and primary care section shall contract with organizations located within the state for the purpose of creating and expanding community-based advanced training which shall include, but is not limited to, nurse practitioner fellowship programs, formal mentoring and precepting programs, and training in community-based ambulatory care settings such as community health centers.  Each program shall be accredited or eligible for accreditation by a nationally-recognized accreditation agency and officially affiliated with a postsecondary educational institution.

21  Governor's Scholarship Program; Health Care Scholarships.  The office of strategic initiatives shall conduct a survey of the health care programs of study offered at postsecondary educational institutions or training programs in the state to determine how the funds appropriated in section 23 of this act should be distributed to ensure the development and enhancement of health care programs of study at postsecondary educational institutions and training programs and the financial solvency of the governor's scholarship program.   

22  Appropriations; Department of Health and Human Services; Rural Health and Primary Care Section.

I.  Area Health Education Centers.  The sum of $1,500,000 for the fiscal year ending June 30, 2020 and the sum of $1,500,000 for the fiscal year ending June 30, 2021 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purpose set forth in paragraph I of section 20 of this act.  The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

II.  State Loan Repayment Program.  The sum of  $3,250,000 for the fiscal year ending June 30, 2020 and the sum of $3,250,000 for the fiscal year ending June 30, 2021 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section to accounting unit 05-95-90-901010-7965, line 103, Contracts for Op Services, and to fund one of the positions established in paragraph II of section 20 of this act.  This appropriation shall be nonlapsing.  Of this appropriation, the sums of $750,000 for the fiscal year ending June 30, 2020 and $750,000 for the fiscal year ending June 30, 2021 shall be expended by clinicians solely to deliver mental health and substance use disorder treatment services in Carroll, Cheshire, and Coos counties.  The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

III.  Primary Care Workforce Program.  The sum of $120,000 for the fiscal year ending June 30, 2020 and the sum of $120,000 for the fiscal year ending June 30, 2021 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section, for the purpose of funding one of the positions established in paragraph II of section 20 of this act.  The commissioner of the department of health and human services may use up to $20,000 of the appropriation in each fiscal year towards the upgrade of an existing position in the rural health and primary care section.  The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

IV.  Workforce Recruitment, Advertising, and Marketing.  The sum of $250,000 for the fiscal year ending June 30, 2020 and the sum of $250,000 for the fiscal year ending June 30, 2021 are hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purpose described in paragraph III of section 20 of this act.  The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

V.  Advanced Training Program.  The sum of $2,000,000 for the biennium ending June 30, 2021 is hereby appropriated to the department of health and human services, division of public health services, rural health and primary care section for the purposes established in paragraph IV of section 20 of this act.  The governor is authorized to draw a warrant for said sum out of any money in the treasury not otherwise appropriated.

23  Appropriation; Governor's Scholarship Program.  The sum of $5,000,000 for the fiscal year ending June 30, 2020 and the sum of $5,000,000 for the fiscal year ending June 30, 2021 are hereby appropriated to the governor’s scholarship fund established in RSA 4-C:34 for the purpose of granting health care scholarships to students pursuant to the governor's scholarship program established in RSA 4-C:32 and to distribute funds to postsecondary educational institutions as provided in section 21 of this act.  From these sums, the office of strategic initiatives shall disburse up to $1,250,000 in each fiscal year as scholarships through the governor's scholarship program for the educational costs of eligible students majoring in an approved health care course of study at a postsecondary institution.  In order to be eligible to receive the governor’s scholarship money for an approved health care course of study, a scholarship applicant shall agree to remain employed in this state in a health care-related field for a minimum of 36 months after graduation from the postsecondary educational institution or training program.  The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

24  Effective Date.  This act shall take effect July 1, 2019.

 

LBAO

19-0895

Revised 2/7/19

 

SB 308-FN-A- FISCAL NOTE

AS INTRODUCED

 

AN ACT relative to the health care workforce and making an appropriation therefor.

 

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

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2020

FY 2021

FY 2022

FY 2023

   Appropriation

$11,370,000

$9,370,000

$0

$0

   Revenue

Indeterminable

Indeterminable

Indeterminable

Indeterminable

   Expenditures

Indeterminable Increase

Indeterminable Increase

Indeterminable Increase

Indeterminable Increase

Funding Source:

  [ X ] General            [    ] Education            [    ] Highway           [ X ] Other - Federal Funds, Criminal Records

 

METHODOLOGY:

This bill:

  • requires the Department of Health and Human Services (DHHS) to increase Medicaid provider rates by 5 percent in FY 2019 and an additional 7 percent in FY 2020;
  • requires licensing boards of certain health professions to promulgate rules requiring licensees to complete a survey administered by the DHHS upon license renewal;
  • directs the DHHS to establish an income eligibility requirement for the Medically Needy optional eligibility group (In and Out Medical Assistance) of less than or equal to 138 percent of the federal poverty level;
  • allows the Department of Safety to contract with a private agency to seal or disclose criminal records pursuant to RSA 16-B:14, I, and requires development of an electronic process to request criminal records online; and
  • clarifies statute relating to telehealth and telemedicine services.

 

This bill also makes general fund appropriations in FY 2020 and FY 2021 to the DHHS and the Office of Strategic Initiatives for the following purposes:

 

 

 

 

 

Agency

Purpose

FY 2020

FY 2021

DHHS – Rural Health and Primary Care

Contract services for programs to improve care and access to care and enhance the public health workforce.

$1,500,000

$1,500,000

DHHS – Rural Health and Primary Care

Fund one of two established classified positions and appropriates funds for the State Loan Repayment Program. These funds are nonlapsing.

$2,500,000

$2,500,000

DHHS – Rural Health and Primary Care

Fund one of two established classified positions and up to $20,000 of the appropriation in each FY for enhancing a current position within Rural and Primary Health Care.

$120,000

$120,000

DHHS – Rural Health and Primary Care

Contract with a nonprofit for a national outreach campaign designed to recruit and retain qualified clinicians.

$250,000

$250,000

DHHS – Rural Health and Primary Care

Contract with a nonprofit to create and expand certain accredited advanced training programs.

$2,000,000

-

Office of Strategic Initiatives

Grant health care scholarships to students and distribute funds to postsecondary education institutions pursuant to the Governor’s Scholarship Program. Up to $1,250,000 of the appropriation in each FY is to be disbursed as scholarships through the program for education costs of students majoring in an approved health care course of study at a postsecondary institution.

$5,000,000

$5,000,000

Total:

$11,370,000

$9,370,000

 

DHHS notes that while the bill's effective date is July 1, 2019, it requires the Department to increase provider rates in FY 2019.  It assumes provider rate increases will be applicable to only Medicaid managed care payments and will not impact other areas with Medicaid providers, such as nursing facilities or the Division for Children, Youth, and Families.  DHHS estimates that, with respect to the traditional Medicaid population, the 5 percent rate increase will cost $38 million in FY 2019 and the 7 percent rate increase will cost $56 million in FY 2020, consisting of 50 percent federal funds and 50 percent general funds.  In addition to the traditional Medicaid population, the increased rates will apply to services provided to participants in the NH Granite Advantage Health Program (NHGAHP), which is currently funded with 93% federal funds, declining to 90% federal funds on January 1, 2020. Expenditures for the NH Health Protection Program, the predecessor to the NHGAHP, were $492 million in FY18.  Using this number as a base, the 5 percent rate increase would increase expenditures by approximately $25 million in FY 2019 and $61 million in FY 2020, of which the state share would be 10 percent once the federal share declines. If program costs were to decline from the $492 million base as a result of the switch to managed care coverage for the NHGHAP population, the increase would be lower.  The Department has projected that base NHGHAP costs may decline to $341 million as a result of managed care coverage, in which case the five percent increase would increase expenditures by $17 million in FY 2019 and $42 million in FY 2020, of which the state share would be 10 percent.  The bill does not contain an appropriation for this purpose.

 

DHHS states the protected income limit for individuals who currently qualify for the In and Out Medical Assistance program is not tied to a percentage of the federal poverty level.  Under this option, a person can have any amount of income and still qualify as medically needy if medical bills are high enough that the individual incurs sufficient medical expenses to reduce their income to the state's standard.  The program is currently for pregnant women, children, parents and other caretaker relatives and the aged, blind, and disabled Medicaid-coverage categories.  DHHS assumes the income limit will be applicable to all medically needy Medicaid-coverable categories.  The Department states the current federal methodology does not permit changing eligibility based on federal poverty level; however, if implemented, eligibility would increase and more individuals would qualify for assistance resulting in an indeterminable increase to expenditures.

 

DHHS also states the impact of the changes to telehealth and telemedicine are indeterminable as the bill does not increase the number of providers able to provide medical services and it is difficult to anticipate the level of utilization for these types of newer services.

 

The Department of Safety states the fiscal impact is indeterminable.  It anticipates there will be additional expenditures to create an independent system for criminal record requests.  Additionally, should the Department contract with a vendor to process the online applications, it may have to increase fees or reduce Criminal Records revenue to cover the vendor costs without increasing fees.

 

The Office of Professional Licensure and Certification states an additional part-time legal professional for one year would be necessary to facilitate required rulemaking for applicable boards.  It estimates expenditures associated with the position to be $20,000 in FY 2020.

 

The Office of Strategic Initiatives anticipates administering and distributing the scholarships through the Governor's Scholarship Program with existing staff and resources.

 

AGENCIES CONTACTED:

Department of Health and Human Services, Department of Safety, Office of Strategic Initiatives, and Office of Professional Licensure and Certification

 

Docket

Date Status
Jan. 3, 2019 Introduced 01/03/2019 and Referred to Executive Departments and Administration; SJ 4
Feb. 13, 2019 ==TIME CHANGE== Hearing: 02/13/2019, Room 101, LOB, 12:00 pm; SC 10
March 14, 2019 Committee Report: Ought to Pass with Amendment # 2019-0870s, 03/14/2019; SC 13
March 14, 2019 Committee Amendment # 2019-0870s, AA, VV; 03/14/2019; SJ 8
March 14, 2019 Ought to Pass with Amendment 2019-0870s, MA, VV; Refer to Finance Rule 4-5; 03/14/2019; SJ 8

Action Dates

Date Body Type
Feb. 13, 2019 Senate Hearing
March 14, 2019 Senate Floor Vote

Bill Text Revisions

SB308 Revision: 5297 Date: Feb. 7, 2019, 11:23 a.m.
SB308 Revision: 5537 Date: March 14, 2019, 4:43 p.m.