Bill Details - SB308 (2019)

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

 

03/14/2019   0870s

03/27/2019   1156s

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

 

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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.  Provides funding 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.

 

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03/14/2019   0870s

03/27/2019   1156s 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 Rate Increases.  The commissioner of the department of health and human services shall increase all Medicaid provider rates, including all state plan services and waiver programs, 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 the 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 provided 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  Governor's Scholarship Program; Funds Distributed.  From any sums appropriated to the governor's scholarship fund established in RSA 4-C:34, the office of strategic initiatives shall disburse up to $1,250,000 for the fiscal year ending June 30, 2020 and up to $1,250,000 for the fiscal year ending June 30, 2021 as scholarships 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.

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

 

LBAO

19-0895

Amended 4/26/19

 

SB 308-FN-A- FISCAL NOTE

AS AMENDED BY THE SENATE (AMENDMENTS  #2019-0870s and #2019-1156s)

 

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

 

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

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2020

FY 2021

FY 2022

FY 2023

   Appropriation

$7,120,000

$5,120,000

$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:

Among other things, this bill: (1) makes appropriations to the Department of Health and Human Services (DHHS) for a variety of purposes; (2) requires DHHS to increase Medicaid provider rates by 5 percent in FY 2020 and an additional 7 percent in FY 2021; and (3) directs DHHS to establish an income eligibility requirement for the Medically Needy optional eligibility group (Medicaid In & Out) of less than or equal to 138 percent of the federal poverty level.

 

With respect to (1), the bill contains the following general fund appropriations in FY 2020 and FY 2021:

Purpose

FY 2020

FY 2021

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

$1,500,000

$1,500,000

Fund one of two established classified positions and appropriate funds for the State Loan Repayment Program.

$3,250,000

$3,250,000

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

$120,000

$120,000

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

$250,000

$250,000

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

$2,000,000

-

Total:

$7,120,000

$5,120,000

 

With respect to (2), the bill is projected to have the following impact on state general fund expenditures and the non-federal share of costs for the Granite Advantage Health Care Program (GAHCP).  The bill does not contain an appropriation for this purpose.

 

General & Non-Federal Fund Impact of Rate Increases

(In Millions)

General Funds

 

Increase Over Base

     Base

$635.4

 

     FY 2020 (After 5% Increase)

$667.2

$31.8

     FY 2021 (After 7% Increase)

$713.9

$78.5

 

Biennial Cost:

$110.2

 

 

 

Non-Federal Share of GAHCP

Increase Over Base

     Base With FY 2020 Funding Mix

$29.4

 

     Base With FY 2021 Funding Mix

$34.6

 

     FY 2020 (After 5% Increase)

$30.9

$1.5

     FY 2021 (After 7% Increase)

$38.9

$4.3

 

Biennial Cost:

$5.8

 

 

 

Combined

 Biennial Cost:

$116.0

 

For informational purposes, the Department notes that the non-federal share of GAHCP costs in FY 2019 is projected to be $22.5 million.  Because the federal share will decline from 93% to 90% effective January 1, 2020, the non-federal share will rise accordingly, reaching $34.6 million in FY 2021 in the absence of this bill.  This bill will have the impact of raising the non-federal share by an additional $4.3 million in FY 2021.  Current state law (RSA 126-AA) limits the available revenue sources that may be used to fund the program, and expressly prohibits the use of general funds for this purpose.  Current law further requires that, in the event the DHHS commissioner determines that insufficient revenue exists to fund projected program costs, he or she must terminate the program.  

 

With respect to (3), DHHS states that under the proposed change, the maximum protected income level under the "Medicaid In and Out" program would increase from $519 to $888 for a household of one and from $675 to $1,033 for a household of two.  This change would result in the elimination of the spend-down requirement for 1,384 individuals, resulting in those individuals enrolling in a managed care organization rather than continuing to participate in the In & Out program.  The Department projects that the state share of costs for managed care coverage of these 1,384 individuals will be between $4.8 million and $9.6 million per year, depending on the percentage of individuals who are dually-eligible for both Medicaid and Medicare.  The Department is unable to determine the cost for those individuals who will remain in the In & Out program but whose spend-down requirements will be reduced as a result of the proposed change.  The bill does not contain an appropriation for this purpose.

 

The bill also contains a variety of provisions with less significant financial impacts than those noted above.  These include:

(a) Requiring licensing boards of certain health professions to promulgate rules requiring licensees to complete a survey administered by DHHS upon license renewal;

(c) Clarifying statute relative to telehealth and telemedicine services; and

(d) Requiring the Department of Safety to develop an electronic process to request criminal records online.

 

With respect to (a), 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 the applicable boards.  It estimates expenditures associated with the position to be $20,000 in FY 2020.

 

With respect to (b), DHHS 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 the Department is unable to anticipate the level of utilization for these types of newer services.

 

Finally, with respect to (c), the Department of Safety states the fiscal impact is indeterminable, but anticipates there will be additional expenditures associated with creating an independent system for criminal records requests.  The Department further states it may need to increase fees or reduce criminal records revenue in order to cover costs.

 

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
March 27, 2019 Committee Report: Ought to Pass with Amendment # 2019-1156s, 03/27/2019; SC 15
March 28, 2019 Committee Report: Ought to Pass with Amendment # 2019-1156s, 03/28/2019; SC 15
March 27, 2019 Special Order to the beginning of the regular calendar, Without Objection, MA; 03/27/2019; SJ 10
March 27, 2019 Committee Amendment # 2019-1156s, AA, VV; 03/27/2019; SJ 10
March 27, 2019 Sen. D'Allesandro Moved Laid on Table, 03/27/2019; SJ 10
March 27, 2019 Sen. D'Allesandro Withdraws motion to Lay on the Table; 03/27/2019; SJ 10
March 27, 2019 Ought to Pass with Amendment 2019-1156s, RC 23Y-0N, MA; 03/27/2019; SJ 10
March 27, 2019 Sen. D'Allesandro Moved Laid on Table, MA, VV; 03/27/2019; SJ 10
March 27, 2019 Pending Motion OT3rdg; 03/27/2019; SJ 10

Action Dates

Date Body Type
Feb. 13, 2019 Senate Hearing
March 14, 2019 Senate Floor Vote
March 28, 2019 Senate Floor Vote
March 27, 2019 Senate Floor Vote
March 27, 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.
SB308 Revision: 5660 Date: April 26, 2019, 1:35 p.m.